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).