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| Effect of COVID-19 Infection on Hemoglobin Level and Iron Metabolism
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Azab Elsayed Azab , J M Jbireal, and Maryouma Nour Alddeen Alnaas
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Abstract:
Background: The coronavirus disease 2019 (COVID-19) is an aggressive virus that spread worldwide and caused a pandemic infection. COVID-19 infection results in an inflammatory state involving a cytokine storm in COVID-19 patients. Interlukin-6 (IL-6) stimulates ferritin and the synthesis of hepcidin. Hepcidin sequesters iron in the enterocytes and macrophages, leading to increased intracellular ferritin, and preventing iron efflux from enterocytes and macrophages. Objectives: The current review aimed to highlight the relationship between COVID-19 Infection, hemoglobin level, and iron metabolism among COVID-19 patients. On March 11, 2020, the world health organization declared COVID-19 a global pandemic. Therefore, The battle against COVID-19 is likely to be a marathon and the pandemic has a major impact on health care systems in many countries. Iron (Fe2+) metabolism is mainly regulated by the coordination between erythropoiesis and Fe stores. Wherever, ferritin level is increased, as it is an acute phase protein, it is always necessary to assess the underlying existence of inflammatory diseases, infectious diseases, and neoplasms. Pathologically, COVID-19 manifests itself in many complications as well as physiological and biochemical alterations. These include, but are not limited to acute respiratory distress syndrome, high concentrations of proinflammatory CD4 T cells and cytotoxic granules CD8 T, massive release of cytokines (cytokine storm), increased coagulation state, hemoglobin damage, and dysregulation of iron homeostasis including iron overload which is likely a major factor in the pathogenesis of COVID-19. Hyperferritinemia is largely considered an indicator of the hyperferritinemic syndromes (HFS) associated with severe COVID-19. Diagnosis of COVID-19 is related to the decreased hemoglobin, leukocytes-neutrophiles ratio, elevated D-dimer, and ferritin. There is a difference in the ability of COVID19 proteins to form a conserved domain with porphyrin according to the number of amino acids and binding energy. Conclusion: It can be concluded that COVID-19 manifests itself in many complications as well as physiological and biochemical alterations. The current review highlighted the relationship between COVID-19 infection, hemoglobin level, and iron metabolism among COVID-19 patients.
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