key: cord-0753205-41arzpan
authors: Marhaeni, Wulandewi; Wijaya, Andreas Budi; Kusumaningtyas, Prabandari; Mapianto, Rahmawan Sakup
title: Thalassemic Child Presenting with Anosmia due to COVID-19
date: 2020-06-09
journal: Indian J Pediatr
DOI: 10.1007/s12098-020-03370-4
sha: f0ab14a90fc82c6e6183765f3d59f26cd1ddb630
doc_id: 753205
cord_uid: 41arzpan

nan

To the Editor: Novel coronavirus (SARS-CoV-2) infection (COVID-19) has spread rapidly in Indonesia. It might also impact on patients with hemoglobin disorders, such as thalassemia [1] . Indonesia has one of the highest prevalence of thalassemia globally [2] .

A 17-y-old girl with transfusion-dependent thalassemia (beta-thalassemia), presented with acute loss of sense of smell (anosmia) and diminished sense of taste (ageusia) since 8 d prior to admission, accompanied by 2 d history of sneezing. History inquiry revealed that she had contact with her father, who was positive for COVID-19. She was admitted to hospital due to pale appearance since 7 d prior to admission. Three days after admission, she also complained mild-moderate muscle aches, which were relieved by using Paracetamol. Lung examination showed normal result. Laboratory studies showed low hemoglobin level (7.5 g/ dl), normal white blood cell count (9.4 × 10 3 /μL), with 54.9% neutrophils and 34.2% lymphocytes, prothrombin time prolongation (PT 14.5 s; normal APTT 31.6 s), hyperuricemia (6.3 mg/dl), and slight increase in C-reactive protein level (6 mg/dl). Ferritin level was 980.51 ng/ml, accompanied by elevated transferrin saturation (88%). Oropharyngeal swab tested positive for SARS-CoV-2. Chest X-ray result was normal. Supportive and therapeutic care such as blood transfusion, antibiotic Azithromycin 500 mg/q24h and antiviral Oseltamivir 75 mg/q12h were given. Deferiprone has still been given, considering her good condition. Anosmia and ageusia might become possible symptoms of COVID-19 in pediatric population with transfusion-dependent thalassemia, as reported in adult cases [3] . Without full objective assessment and nasoendoscopy, precise pathomechanism is still hard to determine. The possible explanation is post-viral syndrome with direct infection of the olfactory mucous and impairment of olfactory sensory neurons [4] .

Erythrocyte is strongly hypothesized for its involvement in COVID-19 pathophysiology, by which SARS-CoV-2 might attack beta chain of hemoglobin. Its turnover will be reduced, followed by cell lysis and development of hemolytic anemia [5] . This condition is interesting, because beta globin chain defect in beta-thalassemia might potentially interrupt the impact of SARS-CoV-2 infection. Therefore, beta-thalassemia patients would not have same risk of COVID-19 as other patients, considering its reduced severity. More studies are needed to have a better understanding of SARS-CoV-2 infection in pediatric population with beta-thalassemia.

Clinical features of pediatric patients with COVID-19: a report of two family cluster cases

Molecular basis of thalassemia

Loss of sense of smell as marker of COVID-19 infection

Isolated sudden onset anosmia in COVID-19 infection. A novel syndrome? Rhinology

COVID-19: attacks the 1-beta chain of hemoglobin and captures the porphyrin to inhibit human heme metabolism

Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations

Conflict of Interest None.