# COVID-19-Associated Severe Aplastic Anemia in an 18-Month-Old Child: A Case Report

## TL;DR

An 18-month-old child developed severe aplastic anemia after a COVID-19 infection and showed partial recovery with treatment.

## Contribution

This case report adds a rare pediatric case of severe aplastic anemia linked to COVID-19.

## Key findings

- The child had severe pancytopenia and bone marrow cellularity <10%, consistent with aplastic anemia.
- SARS-CoV-2 PCR was positive, linking the condition to COVID-19.
- The patient showed partial recovery with romiplostim and blood transfusions, avoiding bone marrow transplantation.

## Abstract

The COVID-19 pandemic has significantly impacted global health since its emergence in late 2019. Established evidence indicates an increasing incidence of hematologic abnormalities caused by COVID-19, such as aplastic anemia. Only a few pediatric cases have been reported. We present a previously healthy 18-month-old boy with fever, cough, diarrhea, rash, and ear discharge for one week. He was febrile, tachycardic, drowsy, with bilateral purulent ear discharge, petechiae, and cervical lymphadenopathy. Blood tests showed severe pancytopenia with high inflammatory markers, and SARS-CoV-2 PCR was positive. Bone marrow biopsy revealed severe aplastic anemia (<10% cellularity), and genetic testing excluded inherited causes. He was treated with blood transfusions and romiplostim. After one year of supportive management, the patient showed a partial response and improving counts, so bone marrow transplantation was deferred, with continued monitoring for sustained hematologic recovery or relapse.