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Table of Contents
LETTER TO THE EDITOR
Year : 2021  |  Volume : 12  |  Issue : 2  |  Page : 106-107

Relation between hematological derangements and disease outcomes in children with COVID-19 are likely indirect


Department of Clinical Hematology, Dayanand Medical College, Ludhiana, Punjab, India

Date of Submission18-Jan-2021
Date of Decision30-Jan-2021
Date of Acceptance30-Jan-2021
Date of Web Publication22-Mar-2021

Correspondence Address:
Dr. Suvir Singh
Department of Clinical Haematology and Stem Cell Transplantation, Dayanand Medical College and Hospital, Ludhiana - 141 001, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/injms.injms_5_21

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How to cite this article:
Singh S. Relation between hematological derangements and disease outcomes in children with COVID-19 are likely indirect. Indian J Med Spec 2021;12:106-7

How to cite this URL:
Singh S. Relation between hematological derangements and disease outcomes in children with COVID-19 are likely indirect. Indian J Med Spec [serial online] 2021 [cited 2021 Aug 2];12:106-7. Available from: http://www.ijms.in/text.asp?2021/12/2/106/311698



Dear Editor,

Margekar et al. provide a succinct review of hematological changes in children with COVID-19 and correctly assert that the link between hematological manifestations and outcomes in children is not well defined.[1] We add few findings from literature to support this assertion. In adults, hematologic parameters have a strong association with outcomes, but several differences indicate that this association in children may not be direct.[2] Children are shown to share many hematological derangements in COVID-19 similar to adults but have several differences in disease pathogenesis.

Several findings from literature affirm that the relation between hematologic derangements and disease outcomes in children is not linear, and may not allow us to correctly predict disease outcomes.

The incidence of severe lung disease in children has been low despite the presence of leukopenia, thrombocytopenia, and coagulopathy.[3] In addition, children with COVID-19 have been described to present with a multisystem inflammatory state (MIS-C), that manifests after primary infection and shares many hematologic disturbances seen in adults.[4] The occurrence of MIS-C after a delay of few weeks from primary infection illustrates the role played by host immune responses and not primary infection per se. Both these facts affirm that final disease manifestations with COVID-19 are a result of differential immune responses in children despite sharing underlying hematologic abnormalities with adults.

Many reasons for the same are being unraveled. For instance, pediatric patients demonstrate markedly different antibody responses to SARS-CoV2 compared to adults.[5] Children also have a markedly high serum concentration of alpha-2-macroglobulin, which plays a role in inhibiting the function of thrombin. This has the ability to blunt downstream inflammatory and prothrombotic responses, reducing disease severity and end-organ damage.[6],[7] MIS-C also shares many pathogenic components with adult COVID-19, including endothelial activation and NETosis, but has completely different manifestations and outcomes, again indicating the role of host responses.

The significance of hematologic parameters in children is still an evolving premise and likely not a direct association like that seen in adults. Continuing accrual of data will provide more insights into this association and help identify clinically relevant parameters.

Financial support and sponsorship

None.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Margekar P, Kumar A, Margekar V, Margekar S. Hematological profile in COVID-19, whether it matters in children. Indian J Med Specialities 2021;12:11-4.  Back to cited text no. 1
    
2.
Maquet J, Lafaurie M, Sommet A, Moulis G. Thrombocytopenia is independently associated with poor outcome in patients hospitalized for COVID-19. Br J Haematol 2020;190:e276-9.  Back to cited text no. 2
    
3.
Al-Ghafry M, Aygun B, Appiah-Kubi A, Vlachos A, Ostovar G, Capone C, et al. Are children with SARS-CoV-2 infection at high risk for thrombosis? Viscoelastic testing and coagulation profiles in a case series of pediatric patients. Pediatr Blood Cancer 2020;67:e28737.  Back to cited text no. 3
    
4.
Ahmed M, Advani S, Moreira A, Zoretic S, Martinez J, Chorath K, et al. Multisystem inflammatory syndrome in children: A systematic review. EClinicalMedicine 2020;26:100527.  Back to cited text no. 4
    
5.
Weisberg SP, Connors TJ, Zhu Y, Baldwin MR, Lin WH, Wontakal S, et al. Distinct antibody responses to SARS-CoV-2 in children and adults across the COVID-19 clinical spectrum. Nat Immunol 2021;22:25-31.  Back to cited text no. 5
    
6.
Becker CG, Harpel PC. Alpha2-macroglobulin on human vascular endothelium. J Exp Med 1976;144:1-9.  Back to cited text no. 6
    
7.
Schramm W, Seitz R, Gürtler L. COVID-19-associated coagulopathy-hypothesis: Are children protected due to enhanced thrombin inhibition by higher α2-macroglobulin macroglobulin (α2-M)? J Thromb Haemost 2020;18:2416-8.  Back to cited text no. 7
    




 

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