At the same time hemophagocytic lymphohistiocytosis (HLH), already reported during SARS-COV2 infection [1], on the basis of major laboratory findings including hyperferritinemia, increase of triglicerides levels and according to the HLH score [2], was suspected in our case and intravenous immunoglobulins (IVIG) 20 g/day were administered for 2 consecutive days (Fig

At the same time hemophagocytic lymphohistiocytosis (HLH), already reported during SARS-COV2 infection [1], on the basis of major laboratory findings including hyperferritinemia, increase of triglicerides levels and according to the HLH score [2], was suspected in our case and intravenous immunoglobulins (IVIG) 20 g/day were administered for 2 consecutive days (Fig. antiviral therapy, steroids and intravenous immunoglobulins. Hemolysis resolved and ferritin dramatically decreased after administration of Ig and a Afull recovery was achieved after viral contamination resolution.This case highlights the novel and multifaceted hematological findings during sever COVID 19 infection. COVID 19-related NVP-BAW2881 pneumonia NVP-BAW2881 is usually mediated by hyper activation of effector T cells and excessive production of inflammatory cytokines, such as IL-6, IL-1, interferon-gamma, and TNF. This inflammatory process called “cytokine storm” is usually a life-threatening complication of COVID 19 contamination. In this case severe immunohematological consequences are reported for the first time and recognition of this complications are probably underestimated. Keywords: Cml, covid-19, NVP-BAW2881 Hemophagocytic lymphohistiocytosis, Cold agglutinin On March 15th, a 55 12 months patient with chronic myeloid leukemia (CML) was admitted in our Emergency Department (ED). He developed sore throat and fever 38 C, productive cough and dyspnoea, 5 days before the admission. Few days before admission he received 2 RCB models. He did not have any direct exposure to Coronavirus Sars-Cov2. He had a history of polyarthritis and ulcerative colitis NVP-BAW2881 treated by salazopyrin and CML in Imatinib 400 mg. At that time quantitative real-time BCR-ABL was: 0.0034 % consistent with MR 4. On ED the most important findings were: haemoglobin (Hgb) 6.6 g/dl, WBC 19.97* 10^9, neutrophils 18.29*10^9, lymphocyte 0.60 *10^9, basophils 0.60*10^9, platelet counts 136*10^9 / L, high-sensitive C reactive-protein 117.4 mg/L, procalcitonine 0.16 ng/mL, LDH 900 UI/L, pH 4.475, pCO2 27.7 mmHg, pO2 64.8 mmHg, Bicarbonates 20mEq/L, SatO2 95 % on room air. Blood coagulation test revealed international normalized ratio (INR) 1.19 and normal fibrinogen but high D-dimer 35,200 ng/mL. Reticulocytes count was low and haptoglobin was within the normal range. No monoclonal spike was found on electrophoresis. RT-PCR was positive for SARS COV2 on nasopharyngeal swab Computerized tomography (CT) of the chest showed the presence of monolateral lung involvement with ground glass opacities and crazy paving appearance (Fig. 1 ). Open in a separate window Fig. 1 Rx and CT at the diagnosis. ground glass opacities and crazy paving apparence. He was treated with low molecular weight heparin, hydroxychloroquine plus lopinavir/ritonavir + ceftriaxone and azithromycin. Blood culture tested unfavorable. On 22nd of March lopinavir was discontinued and darunavir 800 mg/day was added. On 24th of March, during the admission, persisting anemia was noticed and at that time the presence of cold agglutinins was detected. The screening for RBC antibodies and the direct antiglobulin test (DAT) switched positive. DAT investigation with monospecific reagents revealed the presence of IgG, IgM, IgA and C3d (DC Screening, Bio-Rad, Switzerland). The identification of the antibodies, performed using column agglutination technology with commercial red blood cell panels (Identisera and Identisera P, Grifols, Spain), showed the presence of an alloantibody with anti-Lewis b specificity, which was reactive at room heat, in the anti-human globulin phase (AGH) and with papain-treated red blood cells. Concomitant skin rash developed (Fig. 2 ) and methylprednisolone 20 mg/m2 q12 was started. At the same time hemophagocytic lymphohistiocytosis (HLH), already reported during SARS-COV2 contamination [1], on the basis CD96 of major laboratory findings including hyperferritinemia, increase of triglicerides levels and according to the HLH score [2], was suspected in our case and intravenous immunoglobulins (IVIG) 20 g/day were administered for 2 consecutive days (Fig. 3 ). The patient received seven RBC models compatible tested at 37 C, infused using in-line blood warmer without presenting acute or late hemolytic reactions. Four weeks later, antibody screening and identification performed at room heat, in AGH.