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\begin{document}

\title{COVID-19 in a child with severe aplastic anemia}



\author[1]{Yunus Akçabelen}%
\author[1]{Ayça Koca Yozgat}%
\author[1]{Aslinur Ozkaya-Parlakay}%
\author[1]{Nese Yarali}%
\affil[1]{Ministry of Health Ankara City Hospital}%


\vspace{-1em}



  
  \date{May 18, 2024}


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\section*{COVID-19 in a child with severe aplastic
anemia}

{\label{covid-19-in-a-child-with-severe-aplastic-anemia}}

Yunus Murat Ak\selectlanguage{ngerman}çabelen\textsuperscript{1}, Ayça Koca
Yozgat\textsuperscript{1}, Asl\selectlanguage{polish}ı \selectlanguage{english}Nur Parlakay\textsuperscript{2}, Nese
Yarali\textsuperscript{1}

\textsuperscript{1} Department of Pediatric Hematology, Ankara City
Hospital Children's Hospital, Turkiye

\textsuperscript{2} Department of Pediatric Infectious Disease, Ankara
City Hospital Children's Hospital, Turkiye

Article type: Letter to the edit\selectlanguage{ngerman}ör

Running Title: COVID-19 in pediatric aplastic anemia

Key words: COVID-19, children, aplastic anemia

Disclosures: none

Word counts: 625\selectlanguage{english}
\begin{longtable}[]{@{}ll@{}}
\toprule
Abbreviations & Abbreviations\tabularnewline
\midrule
\endhead
SARS-CoV-2 & Severe acute respiratory syndrome coronavirus
2\tabularnewline
WHO & World Health Organization\tabularnewline
QRT-PCR & Quantitative real-time reverse transcription polymerase chain
reaction\tabularnewline
\bottomrule
\end{longtable}

Corresponding author:

Ay\selectlanguage{ngerman}ça Koca Yozgat, MD, Pediatric Hematology Department, Ankara City
Hospital, Ankara, Tel.: 0312-5526000, Email: draycayozgat@yahoo.com,
ORCID: 0000-0001-6690-721X

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a type
of coronavirus first isolated in December 2019 in Wuhan, China. World
Health Organization (WHO) has described SARS-CoV-2 as a pandemic on
March 11, 2020.\textsuperscript{1} As of early May 2020, more than 3
million infected patients and more than 200 thousand deaths have been
reported globally.\textsuperscript{2} It is evident that people of any
age can contract the virus and the underlying medical condition is the
main determinant for the severity of the
disease.\textsuperscript{3}However, since the beginning of the outbreak,
there is paucity of data on the course of disease in children with
primary or acquired immunodeficiency.\textsuperscript{4-9} To our
knowledge, there is no report, in English literature, describing a child
with aplastic anemia and COVID-19. In this report, we describe a child
with aplastic anemia affected with COVID-19.

A 14-year-old boy, who has been followed-up with a diagnosis of severe
aplastic anemia at our hematology department and not currently receiving
active treatment for aplastic anemia, presented with fever, sore throat
and epistaxis for two days. He had had a history of exposure with a
person suspected to have COVID-19. At admission, his body temperature
was 38·5°C and hyperemia of the oropharynx was noted. He had no
tachypnea, dyspnea; no rales or rhonchi were heard on auscultation of
the lungs. His oxygen saturation was normal (\textgreater{}95\%) in room
air. Complete blood count revealed a white blood cell count of
1.70x10\textsuperscript{9}/L, absolute neutrophil count of
0.19x10\textsuperscript{9}/L, absolute lymphocyte count of 1.40
x10\textsuperscript{9}/L, absolute monocyte count of
0.06x10\textsuperscript{9}/L\textbf{,} hemoglobin of 8.3 g/dL, and
platelet count of 12x10\textsuperscript{9}/L. C-reactive protein level
was 0.00221 g/L. The anteroposterior~chest radiograph revealed bilateral
minimal paracardiac infiltration. High resolution computed tomography of
the chest revealed no abnormality including infiltration, consolidation
or ground-glass opacities. Febrile neutropenia treatment with cefepime
was started and platelet suspension was transfused. Test for SARS-CoV-2
by quantitative real-time reverse transcription polymerase chain
reaction (QRT-PCR) from combined nasal and oropharyngeal swab specimen
was positive. On follow up, his body temperature normalized after the
second day of hospitalization. His condition never worsened and oxygen
saturation never decreased. Regular erythrocyte and platelet transfusion
program were continued. On follow-up, no microorganism was isolated in
peripheral blood cultures. Following twice negative repeat QRT-PCR
testing, the patient was discharged on the 15th day of hospitalization
in good condition.

Cases of COVID-19 in age \textless{}20 years comprise around 2\% of the
infected population and mortality in this age group is very
rare.\textsuperscript{4-6} There is an inverse relationship with the age
of the child and severity of the disease,\textsuperscript{6} the
reason(s) of which are still not established.

Unlike older age and co-morbidities including, diabetes, hypertension,
obesity and smoking, there is paucity of data on the impact of
immunosuppression, as a risk factor, on the prognosis of
COVID-19.\textsuperscript{10} Filocamo et al. reported that children
treated with immunosuppressive drugs for rheumatologic disorders do not
have an increased risk of respiratory or life-threatening complications
of COVID-19 compared with the general population.\textsuperscript{11} In
a systematic review, 110 immunosuppressed patients were reported to have
an overall better outcome when compared with other
comorbidities.\textsuperscript{12} One may speculate that
immunocompromised state, \emph{per se} , might be a favorable factor to
limit the inflammatory reaction which commonly accompanies the
moderate/severe disease and is the contributor for such better
prognosis. Such a speculation is contrary to the general opinion that
immunocompromised state increases infection risk, but, indeed, is
paradoxically protective.\textsuperscript{10,12,13}

In our patient, we speculate that both younger age and the
immunocompromised state are the two contributing factors for the very
mild disease. However, further reports with larger sample sizes are
warranted to delineate the impact of immunocompromised states on the
prognosis of children affected with COVID-19.



\section*{References}

{\label{references}}

\begin{enumerate}
\tightlist
\item
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  the media briefing on COVID-19 --- 11 March 2020. March 11, 2020.
\item
  World Health Organization. Coronavirus disease (COVID-19) outbreak.
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  https://www.who.int/emergencies/diseases/novel-coronavirus-2019.{[}Accessed:
  03.05.2020{]}
\item
  Preliminary Estimates of the Prevalence of Selected Underlying Health
  Conditions Among Patients with Coronavirus Disease 2019 --- United
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\item
  Wu Z, McGoogan JM. Characteristics of and important lessons from the
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\item
  Lu X, Zhang L, Du H, Zhang J, Li YY, Qu J, Chinese Pediatric Novel
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\item
  Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, et al. Epidemiological
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\item
  Yu J, Ouyang W, Chua MLK, Xie C. SARS-CoV-2 Transmission in Patients
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\item
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\item
  Sieni E, Pegoraro F, Casini T et al. Favourable outcome of
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\item
  D'Antiga L. Coronaviruses and immunosuppressed patients. The facts
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\item
  Filocamo G,~Minoia F, Carbogno S et al. Absence of severe
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  2020. {[}Epub ahead of print{]}
\item
  Minotti C, Tirelli F, Barbieri E, Giaquinto C, Donà D. How is
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\item
  Balduzzi, A., Brivio, E., Rovelli, A.~\emph{et al.} ~Lessons after the
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\end{enumerate}

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