Coronavirus Disease 2019 in Patients with Thalassemia; Emerging Challenges

Background :

The World Health Organization (WHO) has announced that severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) outbreak is a public health emergency requiring international concern. Thalassemia syndromes are the most prevalent monogenic hemoglobin disorder in world and Iran is located on thalassemia belt, so this type of hemoglobinopathy has a critical importance in our country.

In this overview, the research was conducted by screening the relevant articles evaluating the COVID-19 in patients with thalassemia. An electronic search was performed in online data bases of Scopus, Sid.ir, EMBASE, Cochrane, Web of Science and Medline (via PubMed) with English and Persian language from December 2019 up to November 2020.

Results:

 Overall, 59 articles could be originally identified, 43 of which were excluded and 16 articles have been investigated. Thalassemic patients had a higher risk for severe clinical events due to 2019 novel corona virus. Presence of comorbidities could aggravate the course of COVID-19 in these patients. In thalassemic patients, the protocol of transfusion should not be altered. Also in asymptomatic thalassemic cases, iron chelation should not be stopped but in thalassemic patients with confirmed COVID-19 infection, iron chelation must be discontinued.

Conclusion :

According to low number of reported cases of infected thalassemic patient with confirmed COVID19, there are many unanswered question in management of these vulnerable patients. In this setting treatment decision need to be individualized on a case-by-case basis. In order to deliver an appropriate treatment for these patients, a teamwork between attending clinicians is of utmost importance.