Clinical and Pathophysiological Interactions between COVID-19 and Anemia: Implications for Management

Joan-Lluis Vives-Corrons*, Elena Krisnevskaya, Ines Hernández, Josep-Tomàs Navarro, Cristina Tural Làcher, Roger Paredes Deirós, Lurdes Mateu Pruños, Bonaventura Clotet Sala, Antoni Rosell Gratacos, Jorge Abad Capa, Cristian Morales Indiano, Carolina de la Torre Gomez and Joan Josep Bech

Introduction: The impact of COVID-19 extends beyond the respiratory system, encompassing complex interactions with hematologic parameters. This study investigates how SARS-CoV-2 infection contributes to anemia through alterations in Red Blood Cell (RBC) deformability, enzyme activity, and membrane protein composition, while also evaluating the clinical implications. 

Methods: We conducted a prospective observational study involving 74 individuals, including COVID-19-positive patients (with and without anemia), patients with other viral infections, and healthy controls. RBC-related parameters-including hemoglobin levels, enzyme activities, and Osmotic Gradient Ektacytometry (OGE) profiles-were measured. Proteomic analysis of RBC membranes was performed using advanced omics techniques. In addition, we reviewed the existing literature by searching PubMed, Scopus, and Web of Science for studies related to COVID-19 and anemia up to December 2023, using predefined inclusion criteria to contextualize our findings. 

Results: Anemia was significantly associated with more severe COVID-19 outcomes, including elevated D-dimer, procalcitonin, creatinine, and blood urea nitrogen levels. Proteomic analysis revealed alterations in membrane proteins linked to RBC stability and oxygen delivery. Notably, patients with COVID-19 and anemia exhibited distinct proteomic and deformability profiles compared to non-anemic individuals and those with other viral infections. 

Conclusion: This study highlights the multifactorial nature of anemia in COVID-19, emphasizing its contribution to hypoxia and disease progression. The integration of clinical, rheological, and proteomic data underscores the need for early screening and personalized management of anemia in COVID-19 patients, with potential implications for improving outcomes and informing future therapeutic strategies.

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Published on: Jul 8, 2025 Pages: 5-10

Full Text PDF Full Text HTML DOI: 10.17352/ahcrr.000049
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