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COVID-19 and iron deficiency anemia: relationships of pathogenesis and therapy

https://doi.org/10.17749/2313-7347/ob.gyn.rep.2020.179

Abstract

During pregnancy, a woman becomes more susceptible to respiratory and viral diseases, including novel coronavirus infection (COVID-19). Pregnancy exacerbates the acute inflammation typical to COVID-19, elevating a risk of developing cytokine storm, characterized by an avalanche-like spike of inflammation marker concentrations (C-reactive protein, interleukin-1 в, interleukin-6, interferon-Y, ferritin, erythrocyte sedimentation rate etc.). Cytokine storm increases a risk of pregnancy loss and contribute to formation of multiple organ dysfunction syndrome in pregnant women and fetus. In particular, erythrocyte degradation due to acute inflammation leads to hypoxia and uncontrolled inter-tissue iron redistribution. As a result, conditions are created simultaneously for developing pulmonary hemosiderosis and hemosiderosis of other tissues in pregnant woman and fetus, as well as for augmenting iron loss from the body, which exacerbates iron deficiency anemia (IDA). It is important to emphasize that a surge of ferritin level distinctive for severe COVID-19, does not indicate iron overload. Therefore, recommendations to cancel IDA correction and even to use iron chelators in COVID-19 may increase hypoxia and harm the health of pregnant women.

About the Authors

O. A. Gromova
Institute of Pharmacoinformatics, Federal Research Center «Informatics and Management», Russian Academy of Sciences; Big Data Storage and Analysis Center, Lomonosov Moscow State University
Russian Federation
Olga A. Gromova - MD, Dr Sci Med, Professor, Leading Researcher, Scientific Director, Institute of Pharmacoinformatics, Federal Research Center «Informatics and Management», Russian Academy of Sciences; Leading Researcher, Big Data Storage and Analysis Center, Lomonosov Moscow State University.
42 Vavilova Str., Moscow 119333; 1 Leninskie Gory, Moscow 119234.
Scopus Author ID: 7003589812
Researcher ID: J-4946-2017
Author ID: 94901. WOS ID: J-4946-2017


I. Yu. Torshin
Institute of Pharmacoinformatics, Federal Research Center «Informatics and Management», Russian Academy of Sciences; Big Data Storage and Analysis Center, Lomonosov Moscow State University
Russian Federation
Ivan Yu. Torshin - PhD (Chemistry), PhD in Applied Mathematics, Senior Researcher, Institute of Pharmacoinformatics, Federal Research Center «Informatics and Management», Russian Academy of Sciences; Senior Researcher, Big Data Storage and Analysis Center, Lomonosov Moscow State University.
42 Vavilova Str., Moscow 119333; 1 Leninskie Gory, Moscow 119234.
Scopus Author ID: 7003300274
Researcher ID: C-7683-2018
Author ID: 54104. WOS ID: C-7683-2018


Yu. O. Shapovalova
Lapino Clinic Hospital, MD Medical Group
Russian Federation
Yuliya O. Shapovalova - MD, Obstetrician-Gynecologist, Lapino Clinic Hospital, MD Medical Group.
42 Vavilova Str., Moscow 119333; 1 Leninskie Gory, Moscow 119234.


M. A. Kurtser
Pirogov Russian National Research Medical University, Health Ministry of Russian Federation
Russian Federation
Mark A. Kurtser - MD, Dr Sci Med, Professor, Academician of RAS, Head of the Department of Obstetrics and Gynecology, Faculty of Pediatrics, Pirogov Russian National Research Medical University; General Director of MD Medical Group.
1 Ostrovityanova Str., Moscow 117997.


A. G. Chuchalin
Pirogov Russian National Research Medical University, Health Ministry of Russian Federation
Russian Federation
Alexander G. Chuchalin - MD, Dr Sci Med, Professor, Academician of RAS, Head of the Department of Hospital Therapy, Faculty of Pediatrics, Pirogov Russian National Research Medical University.
1 Ostrovityanova Str., Moscow 117997.


References

1. Poon L.C., Yang H., Dumont S. et al. ISUOG Interim Guidance on coronavirus disease 2019 (COVID-19) during pregnancy and puerperium: information for healthcare professionals - an update. Ultrasound Obstet Gynecol. 2020;55(6):848-62. https://doi.org/10.1002/uog.22061.

2. Poon L.C., Yang H., Lee J.C.S. et al. ISUOG Interim Guidance on 2019 novel coronavirus infection during pregnancy and puerperium: information for healthcare professionals. Ultrasound Obstet Gynecol. 2020;55(5):700-8. https://doi.org/10.1002/uog.22013. PMID: 32160345.

3. Liu H., Wang L.L., Zhao S.J. et al. Why are pregnant women susceptible to COVID-19? An immunological viewpoint. J Reprod Immunol. 2020;139:103122. https://doi.org/10.1016/j.jri.2020.103122. PMID: 32244166.

4. Liu H., Liu F., Li J. et al. Clinical and CT imaging features of the COVID-19 pneumonia: Focus on pregnant women and children. J Infect. 2020;80(5):e7-e13. https://doi.org/10.1016/j.jinf.2020.03.007. PMID: 32171865.

5. Yang Z., Wang M., Zhu Z., Liu Y. Coronavirus disease 2019 (COVID-19) and pregnancy: a systematic review. J Matern Fetal Neonatal Med. 2020 Apr 30:1-4. https://doi.org/10.1080/14767058.2020.1759541. PMID: 32354293. [Online ahead of print].

6. Wong S.F., Chow K.M., Leung T.N. et al. Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome. Am J Obstet Gynecol. 2004;191(1):292-7. https://doi.org/10.1016/j.ajog.2003.11.019. PMID: 15295381.

7. Koumoutsea E.V., Vivanti A.J., Shehata N. et al. COVID-19 and acute coagulopathy in pregnancy. J Thromb Haemost. 2020;18(7):1648-52. https://doi.org/10.1111/jth.14856. PMID: 32302459.

8. Bao J., Li C., Zhang K. et al. Comparative analysis of laboratory indexes of severe and non-severe patients infected with COVID-19. Clin Chim Acta. 2020;509:180-94. https://doi.org/10.1016/j.cca.2020.06.009. PMID: 32511971.

9. Health status of pregnant women, parturients, puerperants and newborns. [Sostoyanie zdorov'ya beremennyh, rozhenic, rodil'nic i novorozhdennyh]. (In Russ.). Available at: https://rosstat.gov.ru/folder/13721. [Accessed: 08.08.2020].

10. Belokrinitskaya T.E., Shapovalov K.G. Influenza and pregnancy. [Gripp i beremennost']. Moskva: GEOTAR-Media, 2015. 144 s. (In Russ.).

11. Sisla B. Guidelines for laboratory hematology. [Rukovodstvo po laboratornoj gematologii. Per. s angl. pod obshch. red. A.I. Vorob'eva]. Moskva: Prakticheskaya medicina, 2011. 352 s. (In Russ.). ISBN: 978-5-98811-199-3.

12. Gromova O.A., Torshin I.Yu. Micronutrients and Reproductive Health. Guideline. [Mikronutrienty i reproduktivnoe zdorov'e. Rukovodstvo]. Moskva: GEOTAR-Media, 2019. 672 s. (In Russ.). https://doi.org/10.33029/9704-5149-6-MNU-2019-1-672.

13. Alserehi H., Wali G., Alshukairi A., Alraddadi B. Impact of Middle East Respiratory Syndrome coronavirus (MERS-CoV) on pregnancy and perinatal outcome. BMC Infect Dis. 2016;16:105. https://doi.org/10.1186/s12879-016-1437-y.

14. Alfaraj SH, Al-Tawfiq JA, Memish ZA. Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection during pregnancy: Report of two cases & review of the literature. J Microbiol Immunol Infect. 2019;52(3):501-3. https://doi.org/10.1016/j.jmii.2018.04.005. PMID: 29907538.

15. Wong S.F., Chow K.M., Leung T.N. et al. Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome. Am J Obstet Gynecol. 2004;191(1):292-7. https://doi.org/10.1016/j.ajog.2003.11.019.

16. Dashraath P., Wong J.L., Lim M.X. et al. Coronavirus disease 2019 (COVID-19) pandemic and pregnancy. Am J Obstet Gynecol. 2020;222(6):521-31. https://doi.org/10.1016/j.ajog.2020.03.021. PMID: 32217113.

17. Torshin I.Yu., Gromova O.A. Micronutrients against coronaviruses. Ed. A.G. Chuchalin. [Mikronutrienty protiv koronavirusov. Pod red. A.G. Chuchalina]. Moskva: GEOTAR-Media, 2020. 112 s. (In Russ.).

18. Perricone C., Bartoloni E., Bursi R. et al. COVID-19 as part of the hyperferritinemic syndromes: the role of iron depletion therapy. Immunol Res. 2020;68(4):213-24. https://doi.org/10.1007/s12026-020-09145-5. PMID: 32681497.

19. Lazarian G., Quinquenel A., Bellal M. et al. Autoimmune haemolytic anaemia associated with COVID-19 infection. Br J Haematol. 2020;190(1):29-31. https://doi.org/10.1111/bjh.16794. PMID: 32374906.

20. Lopez C., Kim J., Pandey A. et al. Simultaneous onset of COVID-19 and autoimmune haemolytic anaemia. Br J Haematol. 2020;190(1):31-2. https://doi.org/10.1111/bjh.16786. PMID: 32369626.

21. Capes A., Bailly S., Hantson P. et al. COVID-19 infection associated with autoimmune hemolytic anemia. Ann Hematol. 2020;99(7):1679-80. https://doi.org/10.1007/s00277-020-04137-9. PMID: 32542444.

22. Dewaele K., Claeys R. Hemophagocytic lymphohistiocytosis in SARS-CoV-2 infection. Blood. 2020;135(25):2323. https://doi.org/10.1182/blood.2020006505. PMID: 3255613.

23. Mendy A., Apewokin S., Wells A.A., Morrow A.L. Factors associated with hospitalization and disease severity in a racially and ethnically diverse population of COVID-19 patients. medRxiv. 2020 Jun 27:2020.06.25.20137323. https://doi.org/10.1101/2020.06.25.20137323. Preprint. PMID: 32607513.

24. Hematology: national guidelines. Ed. O A. Rukavitsyna. [Gematologiya: nacional'noe rukovodstvo. Pod red. O.A. Rukavicyna]. Moskva: GEOTAR-Media, 2015. 776 s. (In Russ.).

25. Takhar A. Pernicious anaemia: switch to oral B12 supplementation to reduce risk of covid-19 transmission. BMJ. 2020;369:m2383. https://doi.org/10.1136/bmj.m2383. PMID: 32554629.

26. Interim guidelines. Prevention, diagnosis and treatment of new coronavirus infection (COVID-19). Version 7. 03.06.2020. [Vremennye metodicheskie rekomendacii. Profilaktika, diagnostika i lechenie novoj koronavirusnoj infekcii (COVID-19). Versiya 7. 03.06.2020]. Minzdrav RF, 2020. 166 s. (In Russ.). Available at: https://static-0.rosminzdrav.ru/system/attachments/attaches/000/050/584/original/03062020_%D0%9CR_COVID-19_v7.pdf. [Accessed: 08.08.2020].

27. Bolondi G., Russo E., Gamberini E. et al. Iron metabolism and lymphocyte characterisation during Covid-19 infection in ICU patients: an observational cohort study. World J Emerg Surg. 2020;15(1):41. https://doi.org/10.1186/s13017-020-00323-2. PMID: 32605582.

28. Zhao K., Huang J., Dai D. et al S. Serum iron level as a potential predictor of coronavirus disease 2019 severity and mortality: A retrospective study. Open Forum Infect Dis. 2020;7(7):ofaa250. https://doi.org/10.1093/ofid/ofaa250. PMID: 32661499.

29. Shah A., Frost J.N., Aaron L. et alH. Systemic hypoferremia and severity of hypoxemic respiratory failure in COVID-19. Crit Care. 2020;24(1):320. https://doi.org/10.1186/s13054-020-03051-w. PMID: 32517773.

30. Bonetti G., Manelli F., Patroni A. et al. Laboratory predictors of death from coronavirus disease 2019 (COVID-19) in the area of Valcamonica, Italy. Clin Chem Lab Med. 2020;58(7):1100-5. https://doi.org/10.1515/cclm-2020-0459. PMID: 32573995.

31. Cai S.H., Liao W., Chen S.W. et al. Association between obesity and clinical prognosis in patients infected with SARS-CoV-2. Infect Dis Poverty. 202029;9(1):80. https://doi.org/10.1186/s40249-020-00703-5. PMID: 32600411.

32. Chowdhury S.F., Anwar S. Management of hemoglobin disorders during the COVID-19 pandemic. Front Med (Lausanne). 2020;7:306. https://doi.org/10.3389/fmed.2020.00306. PMID: 32582745.

33. D'Amico F., Peyrin-Biroulet L., Danese S. Oral iron for IBD patients: lessons learned at time of COVID-19 pandemic. J Clin Med. 2020;9(5):1536. https://doi.org/10.3390/jcm9051536. PMID: 32438763.

34. Chen C., Chen C., Yan J.T. et al. Analysis of myocardial injury in patients with COVID-19 and association between concomitant cardiovascular diseases and severity of COVID-19. Zhonghua Xin Xue Guan Bing Za Zhi. 2020;48(7):567-71. https://doi.org/10.3760/cma.j.cn112148-20200225-00123. PMID: 32141280.

35. Wu G., Yang P., Xie Y. et al. Development of a clinical decision support system for severity risk prediction and triage of COVID-19 patients at hospital admission: an International Multicenter Study. Eur Respir J. 2020;56(2):2001104. https://doi.org/10.1183/13993003.01104-2020. PMID: 32616597.

36. Lagadinou M., Salomou E.E., Zareifopoulos N. et al. Prognosis of COVID-19: Changes in laboratory parameters. Infez Med. 2020;28(suppl 1):89-95. PMID: 32532944.

37. Maksimov V.A., Torshin I.Yu., Chuchalin A.G. et al. The effectiveness and safety of a polypeptide drug (Laennec) for the treatment of COVID-19. [Effektivnost' i bezopasnost' polipeptidnogo preparata (Laennek) v terapii COVID-19]. Eksperimental'naya i klinicheskaya gastroenterologiya. 2020;(6):55-63. (In Russ.). https://doi.org/10.31146/1682-8658-ecg-178-6-55-63.

38. Torshin I.Y., Rudakov K.V. On metric spaces arising during formalization of problems of recognition and classification problems. Part 1: properties of compactness. Pattern Recognition and Image Analysis. 2016;26(2):274. https://doi.org/10.1134/S1054661816020255.

39. Torshin I.Y. Optimal dictionaries of the final information on the basis of the solvability criterion and their applications in bioinformatics. Pattern Recognition and Image Analysis. 2013;23(2):319-27. https://doi.org/10.1134/S1054661813020156.

40. Gromova O.A., Limanova O.A., Gogoleva I.V. et al. Interrelation between magnesium status and risk of somatic diseases in women aged 18-45 years old in Russia: the method of database mining. [Analiz vzaimosvyazi mezhdu obespechennost'yu magniem i riskom somaticheskih zabolevanij u rossiyanok 18-45 let metodami intellektual'nogo analiza dannyh]. Effektivnaya farmakoterapiya. 2014;(23):10-23. (In Russ.).

41. Cavezzi A., Troiani E., Corrao S. COVID-19: hemoglobin, iron, and hypoxia beyond inflammation. A narrative review. Clin Pract. 2020;10(2):1271. https://doi.org/10.4081/cp.2020.1271. PMID: 32509258.

42. Gromova O.A. Torshin I.Yu. The importance of zinc in maintaining the activity of antiviral innate immunity proteins: analysis of publications on COVID-19. [Vazhnost' cinka dlya podderzhaniya aktivnosti belkov vrozhdennogo protivovirusnogo immuniteta: analiz publikacij, posvyashchennyh COVID-19]. Profilakticheskaya medicina. 2020;23(3):125-33. (In Russ.). https://doi.org/10.17116/profmed202023031125.

43. Gromova O.A. Torshin I.Yu., Uchaykin V.F. Micronutrients supporting congenital immunity against coronaviruses: results of a systematic computer analysis of publications on COVID-19 and antiviral proteins of the human proteome. [Mikronutrienty, podderzhivayushchie vrozhdennyj immunitet protiv koronavirusov: rezul'taty sistematicheskogo komp'yuternogo analiza publikacij po COVID-19 i belkov protivovirusnoj zashchity proteoma cheloveka]. Farmakologiya & Farmakoterapiya. 2020;(1):9-25. (In Russ.).

44. Nazarenko O.A., Gromova O.A., Demidov V.I. et al. Comparative evaluation of chronic iron overload in the application of iron preparations in the sub-toxic doses. [Sravnitel'naya ocenka hronicheskoj peregruzki zhelezom pri primenenii preparatov zheleza v subtoksicheskih dozah]. Terapiya. 2016;6(10):82-8. (In Russ.).

45. Gromova O.A., Torshin I.Yu., Khadzhidis A.K. Undesirable effects of ferrous sulfate in obstetric, pediatric and therapeutic practice. [Nezhelatel'nye effekty sul'fata zheleza v akusherskoj, pediatricheskoj i terapevticheskoj praktike]. Zemskij vrach. 2010;(2):39-44. (In Russ.).

46. Gromova O.A., Torshin I.Yu., Tetruashvili N.K. et al. On use of multicomponent vitamin-mineral complexes for prevention of iron deficiency anemia in pregnant women. [Ob ispol'zovanii mnogokomponentnyh vitaminno-mineral'nyh kompleksov dlya profilaktiki zhelezodeficitnoj anemii u beremennyh]. Medicinskij alfavit. 2018;2(13):6-19. (In Russ.).

47. Torshin I.Yu., Gromova O.A., Limanova O.A. et al. A meta-analysis of clinical studies on the use of iron fumarate for the prevention and treatment of iron deficiency anemia in pregnant women. [Metaanaliz klinicheskih issledovanij po primeneniyu fumarata zheleza s cel'yu profilaktiki i terapii zhelezodeficitnoj anemii u beremennyh]. Ginekologiya. 2015;17(5):3-10. (In Russ.).

48. Recommendations to prevent and control iron deficiency in the United States. Centers for Disease Control and Prevention. MMWR Recomm Rep. 1998;47(RR-3):1-29. PMID: 9563847.


Review

For citations:


Gromova O.A., Torshin I.Yu., Shapovalova Yu.O., Kurtser M.A., Chuchalin A.G. COVID-19 and iron deficiency anemia: relationships of pathogenesis and therapy. Obstetrics, Gynecology and Reproduction. 2020;14(5):644-655. (In Russ.) https://doi.org/10.17749/2313-7347/ob.gyn.rep.2020.179

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ISSN 2313-7347 (Print)
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