Extremely severe anemia-Worsening a patient's condition in the COVID-19 pandemic era.

A 52‐year‐old woman was brought to the emergency department due to a loss of consciousness. She had not been treated for any chronic diseases. The patient had a history of recurrent bleeding from the genital tract for at least 2 weeks, weakness, worsening of exercise tolerance, and swelling of the lower limbs. There were no signs of respiratory infection or fever. On admission, the patient was in a severe condition with maintained verbal and logical contact.

Laboratory tests revealed severe microcytic anemia : RBC 1.28 × 1012/L (3.8‐5.2), HGB 1.8 g/L (12.0‐16.0), HCT 7.3% (37.0‐47.0), MCV 57.0 fl (80.0‐96.0), MCH 14.1 fmol (27.0‐31.2), Ret#0.05x1012/L (0.02‐0.14), Ret‐He 15.5 pg (28‐35), WBC 13.80 × 109/L, and PLT 437 × 109/L (Fig 1). In biochemical tests, the following concentrations were observed: troponin I 0.276 ng/L (0.000‐0.056), CK‐MB mass 66.6 µg/L (0.0‐6.6), NT‐proBNP 1586 pmol/L (<125), and elevated CRP 60.2 mg/L(0‐10), with the following enzyme activities: creatine kinase 1001 µkat/L (26‐192), aspartate aminotransferase 1342 µkat/L (5‐40), and alanine aminotransferase 1403 µkat/L (7‐56).

FIGURE 1

Extremely deep microcytic anemia—microscopic image of peripheral blood. Substantial changes were noticed in the red blood cells of the blood microscopic smear: significant hypochromia (+++) and significant microcytosis (+++), significant poikilocytosis: many anulocytes, (+++), stomatocytes (+), ovalocytes (+), polychromatophiles (+), lacrymocytes (+), and slight platelets anisocytosis

Detailed laboratory tests confirmed iron deficiency anemia: iron 14 µmol/L, ferritin 8 ng/mL (30‐400), transferrin 400 g/L (250‐320), and soluble transferrin receptor (sTfR) 63.17 nmol/L (1.79‐4.63). Initially, the patient received 4 units of packed red cells.

Finally, a nascent uterine myoma was diagnosed, which was the cause of the chronic blood loss and severe anemia. In the described case, extremely severe anemia in the patient and a significant decrease in oxygen transport capacity to the tissues caused myocardial ischemia, which resulted in an increase in the concentration of troponin I and transaminases. Despite chronic blood loss from the genital tract, the patient delayed her visit to the hospital due to the COVID‐19 pandemic. At admission, the patient had a negative COVID‐19 test.

According to several reports, the pandemic has significantly influenced emergency department admissions, with an overall reduction in visits by up to 42%. Delayed or refusing to seek medical care is undoubtedly a side effect of the pandemic state—either because of a fear of COVID‐19 or due to recommendations to stay at home. The fatal effects have been already described. , This patient survived thanks to appropriate diagnosis and the timely implementation of treatment; however, we are still seeing an increased number of chronic diseases being delayed to life‐threatening stage, including severe anemia, upon admission to the emergency department.

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