COVID-19–Induced Immune Dysregulation in Community-based Pediatric Autoimmune Hemolytic Anemia: Insights into Onset and Relapse Phases

Autoimmune hemolytic anemia (AIHA) is a rare, but life-threatening hematologic condition in childhood. New evidence indicates that infection with SARS-CoV-2 can precipitate or worsen AIHA, yet systematic pediatric data are lacking.

OBJECTIVE: The study aims to explore the effect of COVID-19 on the onset of child AIHA relapse, report laboratory for differentiation and analyze statistical results. Methods: A retrospective cohort analysis was conducted of 40 children with AIHA. Eighteen of the cases had COVID-19 and 22 did not. Laboratory features, serology, inflammatory markera and relapse ratees were analyzed. Results: Hemoglobin levels were significantly higher, reticulocyte count was significantly higher, LDH level was significant higher, direct and total bilirubin levels were significantly lower and CRP and ESR levels checked before receiving transfusion had high rate of significance in cases of COVID-19–related AIHA when compared to non-COVID (p < 0.04). DAT positivity for both IgG and C3d was more common in the COVID group. The rates of relapse were 33% for the COVID-related group and 9% for the non-COVID group (p >0.04). Conclusion: COVID-19 infection plays an important role in the development and recurrence of AIHA in children by increasing hemolysis and inflammation. Prompt identification of laboratory abnormalities and close follow-up may be life-saving.