Case 3
A 36 weeks preterm boy was delivered by cesarean section due to fetal
decelerations. Pregnancy was complicated by SARS-CoV-2 infection during
the second trimester, type 2 diabetes mellitus, hypertension,
oligohydramnios, and chorioamniotic separation. At 24 hours of life, he
was found to have elevated total bilirubin of 13.6 mg/dL requiring
phototherapy and close to the threshold needing exchange transfusion.
Additional investigations were consistent with intravascular hemolysis
with elevated reticulocyte count, elevated immature reticulocyte
fraction, elevated free plasma hemoglobin (120 mg/dL), elevated LDH
(1853 U/L), low haptoglobin (<8 mg/dL). SARS-CoV-2 antibodies
were reactive (Table 2). Hyperbilirubinemia responded to intensive
phototherapy. Glucose-6 phosphate dehydrogenase (G6PD) level was low at
5.4 units/g Hb.