Prevalence and severity of Coronavirus disease 2019 (COVID-19) in Transfusion Dependent and Non-Transfusion Dependent β-thalassemia patients and effects of associated comorbidities: an Iranian nationwide study: Prevalence and severity of COVID-19 in β-thalassemias

Prevalence and severity of Coronavirus disease 2019 (COVID-19) in Transfusion Dependent and Non-Transfusion Dependent β-thalassemia patients and effects of associated comorbidities: an Iranian nationwide study

Prevalence and severity of COVID-19 in β-thalassemias

Authors

  • Mehran Karimi Hematology research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  • Sezaneh Haghpanah Hematology research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  • Tahereh Zarei Hematology research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  • Azita Azarkeivan Zafar Adult Thalassemia Clinic, Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
  • Afshan Shirkavand Medical Physicist, Pardis Noor Medical Imaging Center, Tehran, Iran
  • Sara Matin Pediatric Department, Jahrom University of Medical Sciences, Jahrom, Iran
  • Maryam Akavan Tavakoli Anatomy Sciences Department, Iran University of Medical Sciences, Tehran, Iran
  • Zohre Zahedi Hematology research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  • Vincenzo De Sanctis Quisisana Hospital, Ferrara

Keywords:

COVID-19, thalassemias, endocrine disorders, comorbidities, sex steroids

Abstract

Background: Coronavirus disease 2019 (COVID-19) outbreak is a global and challenging disease that is accompany with mortality and morbidity. Aim of study: We evaluated the prevalence and the impact of comorbidities in thalassemia Iranian patients affected by COVID-19.  Methods: A multicenter, retrospective, cross-sectional study was conducted across all comprehensive thalassemia centers in Iran, from January to June 15th, 2020. Results: Forty-three confirmed COVID-19 thalassemia patients (32 TDT, and 11 NTDT) were detected. The mean age of patients was 35.3 ± 11.5 years (range 9 - 67); 21 females and 22 males. Overall, 78.1% of TDT and 90.9% of NTDT patients were complicated with at least one comorbidity (P: 0.656). The overall mortality rate of thalassemia patients with COVID-19 was 18.6% while 27.3% was in NTDT patients compared to 15.6% in TDT patients (P:0.401). The dead group had a non-significant higher frequency of endocrinopathies compared to the recovered group (62.5% versus 45.7% P:0.457). Ten female thalassemia patients with positive COVID-19 had hypogonadism, six patients were receiving hormone replacement therapy and all of them recovered (zero death) compared to two deaths from 4 patients who were not receiving hormone replacement therapy (P:0.133). Furthermore, the prevalence of COVID-19 in NTDT patients was significantly higher than the general population (45 per 10,000 versus 22.29 per 10,000 respectively, P:0.018) while the prevalence of TDT was almost similar to the normal population (P:0.539). The mortality rate of COVID-19 was 4.71% in the normal Iranian population compared to 18.6% in β-thalassemias (P: <0.001) at the same date. Conclusions: It is important to acknowledge that β-thalassemia patients, especially young adults/adults, have a chronic condition which may contribute to increase susceptibility to SARS-CoV-2 infection. A higher susceptibility to the infection was observed in patients with NTDT and in untreated hypogonadal female thalassemic patients. However, to confirm these data, more accurate designed studies are needed.

References

. Zou L, Ruan F, Huang M, et al. SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients. N Engl J Med. 2020;382:1177-1179.

Yang J, Zheng Y, Gou X, et al. Prevalence of comorbidities in the novel Wuhan coronavirus (COVID-19) infection: a systematic review and meta-analysis. Int J Infect Dis.2020; S1201-9712(20)30136-3. doi: 10.1016/j.ijid.2020.03.017 pmid:32173574

Karimi M, De Sanctis V. Implications of SARSr-CoV 2 infection in thalassemias: Do patients fall into the "high clinical risk" category? Acta Biomed. 2020;91:50-56.

Karimi M, Haghpanah S, Azarkeivan A, et al. Prevalence and Mortality due to Outbreak of Novel Coronavirus Disease (COVID-19) in β-Thalassemias: The Nationwide Iranian Experience. Br J Haematol. 2020 Jun 2;10.1111/bjh.1691. doi: 10.1111/bjh.16911.

De Sanctis V, Soliman AT, Elsedfy H, et al. Growth and endocrine disorders in thalassemia: The international network on endocrine complications in thalassemia (I-CET) position statement and guidelines. Indian J Endocrinol Metab. 2013;17:8-18.

Taher AT, Musallam KM, Karimi M, et al. Overview on practices in thalassemia intermedia management aiming for lowering complication rates across a region of endemicity: the OPTIMAL CARE study. Blood. 2010;115:1886–1892.

Hussain A, Bhowmik B, do Vale Moreira NC. COVID-19 and diabetes: Knowledge in progress. Diabetes Res Clin Pract. 2020 Apr; 162:108142. doi: 10.1016/j.diabres.2020.108142.

Giefing-Kroll C, Berger P, Lepperdinger G, Grubeck-Loebenstein B. How sex and age affect immune responses, susceptibility to infections, and response to vaccination. Aging Cell. 2015; 14:309-321.

Corman VM, Landt O, Kaiser M, et al. Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR. Euro Surveill. 2020;25(3) https://doi.org/10.2807/1560-7917.

https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200615-covid-19-sitrep-147.pdf.

De Sanctis V, Canatan D, Vives Corrons J, et al. Preliminary Data on COVID-19 in Patients with Hemoglobinopathies: A Multicentre ICET-A Study. Mediterr J Hematol Infect Dis. 2020, 12(1): e2020046 DOI 10.4084/MJHID.2020.046.

Karimi M, Cohan N, De Sanctis V, Mallat NS, Taher A. Guidelines for diagnosis and management of Beta-thalassemia intermedia. Pediat Hematol Oncol. 2014; 31:583-596.

Channappanavar R, Fett C, Mack M, Ten Eyck PP, Meyerholz DK, Perlman S. Sex-Based Differences in Susceptibility to Severe Acute Respiratory Syndrome Coronavirus Infection. J Immunol. 2017; 198:4046–4053.

Robinson DP, Hall OJ, Nilles TL, Bream JH, Klein SL. 17β-estradiol protects females against influenza by recruiting neutrophils and increasing virus-specific CD8 T cell responses in the lungs. J Virol. 2014; 88: 4711-4720.

Downloads

Published

07-09-2020

Issue

Section

ORIGINAL INVESTIGATIONS/COMMENTARIES - SPECIAL COVID19

How to Cite

1.
Karimi M, Haghpanah S, Zarei T, et al. Prevalence and severity of Coronavirus disease 2019 (COVID-19) in Transfusion Dependent and Non-Transfusion Dependent β-thalassemia patients and effects of associated comorbidities: an Iranian nationwide study: Prevalence and severity of COVID-19 in β-thalassemias. Acta Biomed. 2020;91(3):e2020007. doi:10.23750/abm.v91i3.10155