Case 2
A 27 weeks preterm boy was born by cesarean section due to reversed end-diastolic flow and severe intrauterine growth restriction (IUGR). Pregnancy was complicated by maternal history of systemic lupus erythematosus, Chron’s disease, and asymptomatic maternal SARS-CoV-2 infection two months before delivery. On DOL 1, he was found to be pancytopenic, followed on DOL 2 by mild disseminated intravascular coagulation (DIC), which responded to plasma, RBC, and platelet transfusions. The patient had intravascular hemolysis with a hemoglobin of 7.2 g/dL, elevated unconjugated bilirubin (7 mg/dL), lactate dehydrogenase (LDH) of 555 U/L, high reticulocyte count, and plasma free hemoglobin (700 mg/dL); the peripheral smear reported nucleated RBC and schistocytes. The lupus anticoagulant panel was negative. Head ultrasound reported no intraventricular hemorrhage. SARS-CoV-2 antibodies were reactive (Table 2).