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

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.