Acute hemolytic reaction in patients with novel coronavirus pneumonia induced by high-dose ribavirin injection: report of 2 cases

Two female patients (patient 1, 22-year-old;patient 2, 50-year-old) received IV infusion of ribavirin injection (4 g in the first dose and the next day 1 2 g thrice daily), oral 2 lopinavir and ritonavir tablets twice daily, and aerosol inhalation of recombinant human interferon α2b for injection for novel coronavirus pneumonia There was no obvious abnormality in blood routine and liver function before treatment Laboratory tests showed red blood cell count (RBC) 2 89×1012/L, hemoglobin (Hb) 75 g/L, alanine aminotransferase (ALT) 22 8 U/L, aspartate aminotransferase (AST) 33 9 U/L, total bilirubin (TBil) 71 2 μmol/L, and indirect bilirubin (IBil) 63 5 μmol/L in patient 1 on the 2nd day of treatment, and RBC 3 46×1012/L, Hb 95 g/L, ALT 17 7 U/L, AST 21 3 U/L, TBil 86 1 μmol/L, and IBil 67 1 μmol/L in patient 2 on the 3rd day of treatment The direct antiglobulin test was positive, indirect antiglobulin test was negative, and antinuclear antibody test was negative in both patients They were diagnosed as having acute hemolytic anemia Con-sidering the relationship to ribavirin, ribavirin was given in reduced dose and then finally discontinued in patient 1, and was discontinued directly in patient 2 On the basis of continued use of the other 2 drugs, both of them were treated with ursodeoxycholic acid The Hb and bilirubin level of the 2 patients gradually returned to normal Copyright © 2020 by the Chinese Medical Association