A Case of COVID-19 in a Patient with Asymptomatic Hemoglobin D Thalassemia and Glucose-6-Phosphate Dehydrogenase Deficiency
Rare co-existance of disease or pathology
Sreethish Sasi, Mohamed A. Yassin, Arun Prabhakaran Nair, Muna S. Al Maslamani
Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
Am J Case Rep 2020; 21:e925788
Available online: 2020-06-22
Beta-hemoglobinopathies and glucose-6-phosphate dehydrogenase (G6PD) deficiency are genetic disorders that cause hemolytic anemia when exposed to oxidative stress. Their co-existence is, however, not proven to enhance the severity of anemia.
CASE REPORT: We report the case of a young man with no known co-morbidities, who came with fever and cough and was diagnosed with COVID-19 pneumonia. He was found to have hemoglobin D thalassemia and G6PD deficiency during further evaluation. Hydroxychloroquine therapy started initially, was discontinued after 3 doses once the G6PD deficiency was diagnosed. His hospital course showed a mild drop in hemoglobin with evidence of hemolysis on peripheral smear. However, the hemoglobin improved without any need for transfusion.
CONCLUSIONS: Hydroxychloroquine therapy can induce hemolytic crises in patients with underlying G6PD deficiency or hemoglobinopathies and should be avoided or closely monitored. Immediate intervention to stop hydroxychloroquine after 3 doses saved our patient from a major hemolytic crisis. The significance of this case report is that it is the first report that outlines the clinic course of COVID-19 pneumonia in a patient with underlying hemoglobin D disease and G6PD deficiency.
Keywords: COVID-19, Glucosephosphate Dehydrogenase Deficiency, hemoglobinopathies, hydroxychloroquine, SARS Virus