COVID?19?associated oxidative damage to red blood cells

A 9-year-old Afro-Caribbean boy presented with fever, abdominal pain and collapse. Physical examination was normal, as were chest X-ray computed tomography of his head. Urinalysis showed microscopic haematuria proteinuria. reverse transcription polymerase chain reaction (RT-PCR) positive for SARS-CoV-2 RNA. His full blood count on presentation a haemoglobin concentration 99 g/l, mean cell volume (MCV) 59.7 fl, reticulocyte 89 × 109/l, white 8.4 109/l platelet 137 109/l. Lactate dehydrogenase (LDH) elevated at 657 iu/l an bilirubin 42 ?mol/l alanine transaminase 195 iu/l. direct Coombs test negative the result glucose-6-phosphate-dehydrogenase assay 17.8 iu/g Hb (normal range 8.8–12.8). High performance liquid chromatography A2 6.1% suggesting diagnosis ? thalassaemia trait. Blood film (image) evidence oxidative haemolysis numerous blister hemighost cells (long arrows), keratocytes (short irregularly contracted echinocytes. The patient had received no drugs known to cause haemolysis. sample referred regional genetics laboratory further evaluation possible enzymopathies by Next-Generation Sequencing. This heterozygous pathogenic variant HBB, Monroe, which has phenotype ?0 G6PD mutation or other profound changes.