The significance of antiglobulin (Coombs) test reactivity in patients with COVID-19 |
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Affiliation: | 1. NMC Royal Hospital, 16th Street, Khalifa City, Abu Dhabi, United Arab Emirates;2. Medical Research Division, Department of Internal Medicine, The National Research Center, Cairo, Egypt;3. Internal Medicine Department, Zagazig School of Medicine, Zagazig, Egypt |
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Abstract: | Previous case reports have described patients with COVID-19-associated autoimmune hemolytic anemia (AIHA), and cold agglutinin disease (CAD) which is characterized by a positive direct antiglobulin (DAT) or “Coombs” test, yet the mechanism is not well understood. To investigate the significance of Coombs test reactivity among COVID-19 patients, we conducted a retrospective study on hospitalized COVID-19 patients treated at NMC Royal Hospital between 15 April and 30 May 2020. There were 27 (20%) patients in the Coombs-positive group and 108 (80%) in the Coombs-negative group. The cold agglutinin titer was examined in 22 patients due to symptoms suggestive of cold agglutinin disease, and all tested negative. We demonstrated a significant association with reactive Coombs test results in univariate analysis through clinical findings such as ICU admission rate, the severity of COVID-19, and several laboratory findings such as CRP, D-dimer, and hemoglobin levels lactate dehydrogenase, and RDW-CV. However, only hemoglobin levels and disease severity had a statistically significant association in multivariate analysis. A possible explanation of COVID-19-associated positive Coombs is cytokine storm-induced hyperinflammation, complement system activation, alterations of RBCs, binding of SARS-CoV-2 proteins to hemoglobin or its metabolites, and autoantibody production. Coombs-positive patients were tested for hemolysis using indirect bilirubin, consumed haptoglobin, and/or peripheral smear that ruled out any evidence of hemolysis. Understanding this etiology sheds new light on RBC involvement as a pathophysiological target for SARS-CoV-2 by interfering with their function; consequently, therapies capable of restoring RBC function, such as erythrocytapheresis, could be repurposed for the treatment of worsening severe and critical COVID-19. |
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Keywords: | Antiglobulin (Coombs) test Red blood cell Anemia Hemolysis Hemoglobinopathy Erythrocytapheresis AIHA" },{" #name" :" keyword" ," $" :{" id" :" pc_Kss5LvqyWu" }," $$" :[{" #name" :" text" ," _" :" autoimmune hemolytic anemia CAD" },{" #name" :" keyword" ," $" :{" id" :" pc_iuYfA370ar" }," $$" :[{" #name" :" text" ," _" :" cold agglutinin disease DAT" },{" #name" :" keyword" ," $" :{" id" :" pc_TwDbIUl5u9" }," $$" :[{" #name" :" text" ," _" :" direct antiglobulin test RDW-CV" },{" #name" :" keyword" ," $" :{" id" :" pc_q6I56i1JDE" }," $$" :[{" #name" :" text" ," _" :" red blood cell distribution width |
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