A Case of Allogenic Peripheral Blood Stem Cell Harvest in a Paroxysmal Nocturnal Hemoglobinuria (PNH) Patient from a Covid Positive Donor: Managing the Unpreventable

Chowdhry M

Published on: 2023-02-06

Abstract

Background

Severe acute respiratory syndrome coronavirus 2 (SARS- CoV- 2) affected medical services globally in several aspects. According to the World Health Organization (WHO) data, COVID-19 was reported in 64.38 crore people and resulted in the mortality of 66.30 lakh worldwide as of 12.12.2022 [1].

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, acquired disease caused by clonal expansion of one or more hematopoietic stem cell (HSC) lines due to a somatic mutation of the phosphatidylinositol glycan anchor (PIG-A) gene located on Xp22.1. PNH can affect multiple systems in the body and requires multidisciplinary clinical management. Patients can manifest with severe pancytopenia, life-threatening thrombosis affecting the hepatic, abdominal, cerebral, and subdermal veins, and high requirements for blood transfusion due to haemolytic anemia. PNH can also be associated with bone marrow failure [2]. Advances in diagnostic techniques and a targeted therapeutic approach for PNH have emerged in the last two decades. Eculizumab, a promising humanized monoclonal antibody against C5, is the first approved therapy for PNH [2] HSCT is a high-risk procedure and is still associated with almost 30% of mortality mainly due to infections and acute graft-versus-host disease (GvHD). However, it is the only curative treatment available for patients with PNH. In this paper we describe a PNH patient who received a successful peripheral blood stem cell (PBSC) transplant from an asymptomatic COVID-positive donor.