The Persistence of COVID-19-Related Pancytopenia as A Possible Sign of Hairy Cell Leukemia: A Case Report

CASE REPORT
Alma Barbullushi (Rucaj), Anila Kristo, Andi Davidhi, Ilda Kullolli

 
International Journal of Biomedicine. 2023;13(2):357-360.
DOI: 10.21103/Article13(2)_CR5
Originally published June 5, 2023

Abstract: 

COVID-19 is known to cause many hematological abnormalities, such as thrombocytopenia, leucopenia, and lymphopenia. Pancytopenia, a decrease in all peripheral blood cell lines, is a rare complication not commonly seen in patients with COVID-19. We report a case of a patient who experienced COVID-19 infection with mild clinical symptoms like fever, fatigue, and muscle and bone aches. The laboratory examinations revealed pancytopenia, mainly neutropenia, thrombocytopenia, mild anemia, and relative lymphocytosis, which persisted after infection resolution. The splenomegaly in abdominal echography and the characteristics of lymphocyte elements in peripheral blood smear examination raised suspicion of the presence of hairy cell leukemia (HCL); therefore, the patient was further examined with a bone marrow biopsy, which confirmed the diagnosis. The persistence of pancytopenia after recovery from COVID-19 infection, especially in patients with splenomegaly, should raise suspicion of another hematological coexistence diagnosis like HCL.

Keywords: 
COVID-19 • hairy cell leukemia • pancytopenia
References: 
  1. Coronaviridae Study Group of the International Committee on Taxonomy of Viruses. The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol. 2020 Apr;5(4):536-544. doi: 10.1038/s41564-020-0695-z.
  2. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al.; China Medical Treatment Expert Group for Covid-19. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020 Apr 30;382(18):1708-1720. doi: 10.1056/NEJMoa2002032. 
  3. Zhou M, Zhang X, Qu J. Coronavirus disease 2019 (COVID-19): a clinical update. Front Med. 2020 Apr;14(2):126-135. doi: 10.1007/s11684-020-0767-8.
  4. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020 Feb 15;395(10223):497-506. doi: 10.1016/S0140-6736(20)30183-5.
  5. Fan BE, Chong VCL, Chan SSW, Lim GH, Lim KGE, Tan GB, Mucheli SS, Kuperan P, Ong KH. Hematologic parameters in patients with COVID-19 infection. Am J Hematol. 2020 Jun;95(6):E131-E134. doi: 10.1002/ajh.25774. Epub 2020 Mar 19. Erratum in: Am J Hematol. 2020 Nov;95(11):1442. 
  6. Pascutti MF, Erkelens MN, Nolte MA. Impact of Viral Infections on Hematopoiesis: From Beneficial to Detrimental Effects on Bone Marrow Output. Front Immunol. 2016 Sep 16;7:364. doi: 10.3389/fimmu.2016.00364.
  7. Zhao Y, He J, Wang J, Li WM, Xu M, Yu X, et al. Development of pancytopenia in a patient with COVID-19. J Med Virol. 2021 Mar;93(3):1219-1220. doi: 10.1002/jmv.26566. 
  8. Sano H, Murakami K, Yokoyama H, Suzuki C, Iwasaki Y, Kodama E, Sugiura H. COVID-19 in a Hairy Cell Leukemia Patient: A Rare Case Report. Tohoku J Exp Med. 2022 Aug 10;258(1):63-68. doi: 10.1620/tjem.2022.J058.
  9. Lim AYH, Goh JL, Chua MCW, Heng BH, Abisheganaden JA, George PP. Temporal changes of haematological and radiological findings of the COVID-19 infection-a review of literature. BMC Pulm Med. 2021 Jan 22;21(1):37. doi: 10.1186/s12890-020-01389-z. 
  10. Keykavousi K, Nourbakhsh F, Abdollahpour N, Fazeli F, Sedaghat A, Soheili V, Sahebkar A. A Review of Routine Laboratory Biomarkers for the Detection of Severe COVID-19 Disease. Int J Anal Chem. 2022 Oct 11;2022:9006487. doi: 10.1155/2022/9006487.
  11. Coperchini F, Chiovato L, Croce L, Magri F, Rotondi M. The cytokine storm in COVID-19: An overview of the involvement of the chemokine/chemokine-receptor system. Cytokine Growth Factor Rev. 2020 Jun;53:25-32. doi: 10.1016/j.cytogfr.2020.05.003. 
  12. Mahmudpour M, Roozbeh J, Keshavarz M, Farrokhi S, Nabipour I. COVID-19 cytokine storm: The anger of inflammation. Cytokine. 2020 Sep;133:155151. doi: 10.1016/j.cyto.2020.155151. 
  13. Tavakolpour S, Rakhshandehroo T, Wei EX, Rashidian M. Lymphopenia during the COVID-19 infection: What it shows and what can be learned. Immunol Lett. 2020 Sep;225:31-32. doi: 10.1016/j.imlet.2020.06.013. 
  14. Liu Y, Du X, Chen J, Jin Y, Peng L, Wang HHX, Luo M, Chen L, Zhao Y. Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. J Infect. 2020 Jul;81(1):e6-e12. doi: 10.1016/j.jinf.2020.04.002. 
  15. Borges L, Pithon-Curi TC, Curi R, Hatanaka E. COVID-19 and Neutrophils: The Relationship between Hyperinflammation and Neutrophil Extracellular Traps. Mediators Inflamm. 2020 Dec 2;2020:8829674. doi: 10.1155/2020/8829674.
  16. Wool GD, Miller JL. The Impact of COVID-19 Disease on Platelets and Coagulation. Pathobiology. 2021;88(1):15-27. doi: 10.1159/000512007. 
  17. Bashash D, Hosseini-Baharanchi FS, Rezaie-Tavirani M, Safa M, Akbari Dilmaghani N, Faranoush M, Abolghasemi H. The Prognostic Value of Thrombocytopenia in COVID-19 Patients; a Systematic Review and Meta-Analysis. Arch Acad Emerg Med. 2020 Sep 19;8(1):e75. 
  18. Lin E, Araj E, Markantonis J, Luu H, Chen M. Hematologic Complications in Patients Hospitalized with COVID-19 Infection. Hematol Rep. 2022 Jul 11;14(3):228-234. doi: 10.3390/hematolrep14030031. 
  19. Levi M, Thachil J, Iba T, Levy JH. Coagulation abnormalities and thrombosis in patients with COVID-19. Lancet Haematol. 2020 Jun;7(6):e438-e440. doi: 10.1016/S2352-3026(20)30145-9. 
  20. Bomhof G, Mutsaers PGNJ, Leebeek FWG, Te Boekhorst PAW, Hofland J, Croles FN, Jansen AJG. COVID-19-associated immune thrombocytopenia. Br J Haematol. 2020 Jul;190(2):e61-e64. doi: 10.1111/bjh.16850.
  21. Fan BE, Chong VCL, Chan SSW, Lim GH, Lim KGE, Tan GB, et al. Hematologic parameters in patients with COVID-19 infection. Am J Hematol. 2020 Jun;95(6):E131-E134. doi: 10.1002/ajh.25774. Epub 2020 Mar 19. Erratum in: Am J Hematol. 2020 Nov;95(11):1442.
  22. Agbuduwe C, Basu S. Haematological manifestations of COVID-19: From cytopenia to coagulopathy. Eur J Haematol. 2020 Nov;105(5):540-546. doi: 10.1111/ejh.13491.
  23. Bouroncle BA, Wiseman BK, Doan CA. Leukemic reticuloendotheliosis. Blood. 1958;13(7):609-630. Blood. 2016 Mar 24;127(12):1519. doi: 10.1182/blood-2016-01-696179. 
  24. Kreitman RJ, Arons E. Update on hairy cell leukemia. Clin Adv Hematol Oncol. 2018 Mar;16(3):205-215.
  25. Tiacci E, Trifonov V, Schiavoni G, Holmes A, Kern W, Martelli MP, et al. BRAF mutations in hairy-cell leukemia. N Engl J Med. 2011 Jun 16;364(24):2305-15. doi: 10.1056/NEJMoa1014209. 
  26. Tiacci E, Schiavoni G, Martelli MP, Boveri E, Pacini R, Tabarrini A, et al. Constant activation of the RAF-MEK-ERK pathway as a diagnostic and therapeutic target in hairy cell leukemia. Haematologica. 2013 Apr;98(4):635-9. doi: 10.3324/haematol.2012.078071. 
  27. Grever MR, Abdel-Wahab O, Andritsos LA, Banerji V, Barrientos J, Blachly JS, et al. Consensus guidelines for the diagnosis and management of patients with classic hairy cell leukemia. Blood. 2017 Feb 2;129(5):553-560. doi: 10.1182/blood-2016-01-689422. 
  28. Barut B, Chauhan D, Uchiyama H, Anderson KC. Interleukin-6 functions as an intracellular growth factor in hairy cell leukemia in vitro. J Clin Invest. 1993 Nov;92(5):2346-52. doi: 10.1172/JCI116839. 
  29. Frassoldati A, Lamparelli T, Federico M, Annino L, Capnist G, Pagnucco G, et al. Hairy cell leukemia: a clinical review based on 725 cases of the Italian Cooperative Group (ICGHCL). Italian Cooperative Group for Hairy Cell Leukemia. Leuk Lymphoma. 1994 Apr;13(3-4):307-16. doi: 10.3109/10428199409056295. 
  30. Kohla S, Ibrahim FA, Aldapt MB, ELSabah H, Mohamed S, Youssef R. A Rare Case of Hairy Cell Leukemia with Unusual Loss of CD123 Associated with COVID-19 at the Time of Presentation. Case Rep Oncol. 2020 Dec 4;13(3):1430-1440. doi: 10.1159/000512830.
  31. Bellmann-Weiler R, Burkert F, Schwaiger T, Schmidt S, Ludescher C, Oexle H, Wolf D, Weiss G. Janus-faced course of COVID-19 infection in patients with hematological malignancies. Eur J Haematol. 2020 Oct;105(4):502-504. doi: 10.1111/ejh.13470. 
  32. Lamure S, Salmanton-García J, Robin-Marieton E, Jaksic O, Kohn M, Marchesi F, et al. COVID-19 and hairy-cell leukemia: an EPICOVIDEHA survey. Blood Adv. 2022 Jul 12;6(13):3870-3874. doi: 10.1182/bloodadvances.2022007357. 

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Received April 4, 2023.
Accepted May 9, 2023.
©2023 International Medical Research and Development Corporation.