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Mervat A M youssef
Ebtisam Shawky hmed
Dalia Tarik Kamal
khalid Elsayh,
Mai A Abdelfatta
Hyam Hassan Mahran Mahran
Mostafa M Embaby


Bone marrow failure, SARS-CoV-2 infection, Children


Viral infections can cause direct and indirect damage to hematopoietic stem cells.

The objectives of this study were to identify the frequency and severity of aplastic anemia in Severe acute respiratory syndrome coronavirus 2 ( SARS-CoV-2) infected children as well as recognition of the response to treatment

Methodology: 13 children with newly-diagnosed severe aplastic anemia enrolled in this prospective clinical trial. Blood samples were obtained from all patients to detect SARS-CoV-2 antibodies, and nasopharyngeal swabs were collected for reverse-transcription Polymerase Chain Reaction to detect  SARS-CoV-2 viruses.  According to the laboratory results,  patients were classified in to SARS-CoV-2 positive  antibodies and SARS-CoV-2  negative antibodies .  Both groups received combined cyclosporine (CsA) + Eltrombopag (E-PAG). The hematological response either complete response (CR)or partial response (PR), no response (NR) and overall response (OR) rates of combined E-PAG + CsA treatment after 6 months were evaluated.

Results: Four children were recognized to have aplastic anemia and SARS-CoV-2 positive antibodies. Two patients fulfilled the hematological criteria for CR and no longer required transfusion of packed red blood cells (PRBCs) or platelets and  one had PR  and were still PRBC transfusion-dependent but no longer required platelet transfusion. The remaining patient showed NR and he had died before reaching the top of the  HSCT waiting list. Moreover, six patients in the SARS-CoV-2 negative antibodies group had CR while three patients had PR. The difference in ANC, Hg, and platelet counts between both groups was not significant.

Conclusion: SARS-CoV-2 virus is added to several viral infections known to be implicated in the pathogenesis of aplastic anaemia. Studies are needed to establish a definitive association and determine whether the response of bone marrow failure to standard therapy differ from that of idiopathic cases.


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