LAUSR

Non transfusion dependent thalassemia (NTDT) are a wide spectrum of genetic diseases characterized by anemia, ineffective erythropoiesis and hemolysis which require blood transfusion supplies only in particular conditions such as pregnancy, infections and trauma. Here we present a case of ischemic colitis (IC) in a patient with NTDT following Coronavirus disease 2019 caused by SARS-COV-2 infection. EP is a 41-year-old male patient attending to our Thalassemia Unit since he was 4 years old when he received also his first blood transfusion. He was found to be heterozygous for b0 39 nonsense C!T mutation along with the db-thalassemia allele with a baseline hemoglobin almost completely (97%) represented by HbF. He has a severe/high risk form of NTDT. He was regularly transfused from 4 to 14 years old. Splenectomy was performed when he was 15 years old; thereafter, he received occasional transfusions only in case of infections. His baseline hemoglobin was about 8.2–8.9 g/dL. In 2004, to relieve anemia and stop the progression of extramedullary erythropoietic masses previously diagnosed, the patient was started on hydroxyurea (HU) therapy. His hemoglobin increased by approximately 1.5 g/dL, but despite HU treatment, platelet and nucleated red blood cell (NRBC) count still were high (650-750 10/L and 600-800 10/L, respectively) and therefore was under prophylactic anti-thrombotic therapy with ASA at dose of 100mg/die. Presently, he shows level of soluble transferrin receptor (sTfR) equal to 12mg/L and is affected by osteoporosis and hypothyroidism and is under thyroid hormone replacement therapy; he has a negative genetic thrombophilia profile and a negative family history for thrombosis. On 15 October 2020, the patient reported to suffer from fever, pharyngodynia, dry cough and headaches, and was able to breathe normally without oxygen. A nasopharyngeal swab for SARS-COV-2 RT-PCR was positive and therefore he was started on clarithromycin 500mg bis in die and prednisone 25mg/die for 7 days and then dose reduction. He was since a week afebrile and anosmic, without cough and headaches, when suddenly started to suffer from abdominal spasmodic pain, vomiting and hematochezia. On day 17 after first symptoms of SARS-COV-2, he presented to emergency department because of the worsening of gastrointestinal symptoms. The SARS-CoV-2 qualitative serology (IgG/IGM) and the nasopharyngeal swab were both positive. His hemoglobin was 9.4 g/dL (13.5–17.5 g/dL), and the mean corpuscular volume (MCV) was 84.2 fL (82–97 fL). White cell counts showed leucocytosis 29.43 10/lL (4.5–10 10/ lL), but NRBC count was within his historical range (730 10/L); lactate dehydrogenase