Key Pathogenic Factors in Coronavirus Disease 2019-Associated Coagulopathy and Acute Lung Injury Highlighted in a Patient With Copresentation of Acute Myelocytic Leukemia: A Case Report

• Published in: A&A practice Vol. 15; no. 4; p. e01432
• Main Authors: Olson, Lyra B, Naqvi, Ibtehaj A, Turner, Daniel J, Morrison, Sarah A, Kraft, Bryan D, Chen, Lingye, Sullenger, Bruce A, Nair, Smita K, Que, Loretta G, Levy, Jerrold H
• Format: Journal Article
• Language: English
• Published: United States 30.03.2021
• Subjects: Acute Lung Injury - complications; Acute Lung Injury - diagnosis; Acute Lung Injury - pathology; Blood Coagulation Disorders - complications; Blood Coagulation Disorders - diagnosis; Blood Coagulation Disorders - pathology; Bronchoalveolar Lavage; COVID-19 - complications; COVID-19 - diagnosis; COVID-19 - pathology; Flow Cytometry; Humans; Leukemia, Myeloid, Acute - complications; Leukemia, Myeloid, Acute - diagnosis; Leukemia, Myeloid, Acute - pathology; Male; Middle Aged; Neutropenia - complications; Neutropenia - diagnosis; Neutropenia - pathology; SARS-CoV-2; Thrombelastography; Virulence Factors
• ISSN: 2575-3126
• DOI: 10.1213/XAA.0000000000001432

The role of concurrent illness in coronavirus disease 2019 (COVID-19) is unknown. Patients with leukemia may display altered thromboinflammatory responses. We report a 53-year-old man presenting with acute leukemia and COVID-19 who developed thrombotic complications and acute respiratory distress syndrome. Multiple analyses, including rotational thromboelastometry and flow cytometry on blood and bronchoalveolar lavage, are reported to characterize coagulation and immune profiles. The patient developed chemotherapy-induced neutropenia that may have protected his lungs from granulocyte-driven hyperinflammatory acute lung injury. However, neutropenia also alters viral clearing, potentially enabling ongoing viral propagation. This case depicts a precarious equilibrium between leukemia and COVID-19.