P58 | An unusual pancytopenia

L. Delle Donne, L. Lenzi, M. Bertoldi, S. Rizzardo, S. Cozzio| Medicina Interna, Rovereto, Italy

Introduction: SARS CoV2 infection can affect various organs and systems. The laboratory aspects include lymphopenia and thrombocytopenia.
Case presentation: 74 year old male patient, admitted to the emergency room for asthenia, chest discomfort. Suffering from chronic inflammatory demyelinating polyneuropathy, treated with prednisone 25 mg and azathioprine 50 mg. Apiretic, objectivity normal, except for weakness in the lower limbs. No respiratory failure, chest x-ray negative for pneumonia, blood tests leukocytes (WBC) 2.4x109/L, hemoglobin (Hb) 8.9 g/dL, C-reactive protein 148 mg/L (vn <6), platelets normal. Nasopharyngeal swab FREND COVID-19 Ag positive. Hospitalized, azathioprine therapy suspended, onset of fever. Rapidly worsening pancytopenia, nadir after the sixth day with total WBC 0.6 x109/L, platelets 16,000, Hb 7 g/dL. Excluding vitamin deficiencies. Patient treated with piperacillin-tazobactam, remdesivir, granulocyte growth factor (G-CSF) and blood transfusions. The patient underwent bone marrow aspirate from the iliac crest with a modest increase in the blast rate (possible effect of G-CSF) with slow maturation of the granulocyte series and no significant signs of dysplasia affecting the elements of the hematopoietic matrix. Nine days after admission, the blood count improved, with very rapid restoration of normal values and complete clinical recovery.
Conclusions: Severe pancytopenia represents a rare complication of SARS-CoV2. In pancytopenic patients it is useful to exclude SARSCoV2 infection to avoid subjecting the patient to invasive diagnostics.