Patients with sickle cell anemia often receive multiple red blood cell (RBC) transfusions during their lifetime. Hyperhemolysis is a life-threatening phenomenon of accelerated hemolysis and worsening anemia that occurs when both transfused RBCs and autologous RBCs are destroyed. The level of hemoglobin post-transfusion is lower than pre-transfusion levels, and patients are usually hemodynamically unstable. Hyperhemolysis must be differentiated from a delayed hemolytic transfusion reaction during which destruction of transfused RBC is the cause of anemia. Hyperhemolysis syndrome can be differentiated into acute (within seven days) and chronic forms (after seven days) post-transfusion. The authors present a case of acute hyperhemolysis syndrome in a patient with sickle cell anemia refractory to steroids and IVIG, which are the treatment of choice. The patient was treated with tocilizumab, combined with supportive measures of erythropoietin, iron, vitamin B12, and folate.

Immune thrombocytopenia (ITP), also known as immune thrombocytopenic purpura, is a hematological disorder characterized by a decreased platelet count, predisposing patients to bleeding. Coronavirus disease 2019 (COVID-19) has been linked to multiple cases of newly diagnosed ITP and is usually found in moderate-to-severe infections, peaking in children and elderly adults. Menorrhagia is the medical term for menstrual periods with abnormally heavy or prolonged bleeding occurring at regular intervals or prolonged uterine bleeding lasting more than seven days. Here, we report the case of a 23-year-old African American female who presented with the chief complaint of menorrhagia and was subsequently diagnosed as having ITP induced by an asymptomatic COVID-19 infection.

Quinine has been used worldwide to treat malaria; however, it is now used as an agent for night-time muscle cramping. The compound, derived from Cinchona tree bark, is found in antimalaria medication, supplements for leg cramping, and beverages such as tonic water and bitter lemon. Quinine, however, is not without its side effect profile which includes a wide range of ailments ranging from nausea to disseminated intravascular coagulation. The authors present a case of a 35-year-old man diagnosed with disseminated intravascular coagulation due to an excessive intake of tonic water because his friend told him that it would help alleviate nighttime leg cramping. We strive to inform physicians about the side effect profile of quinine and stress that a pertinent history must be elicited in patients with unknown causes of disseminated intravascular coagulation.

Coronavirus disease 2019 (COVID-19) has caused significant morbidity and mortality in a vast majority of the patient population, especially those with malignancies. Chronic lymphocytic leukemia (CLL) is the most common leukemia in adults and is often an indolent disease. High white blood cell counts greater than 120 k/cumm in chronic lymphocytic leukemia may be implicated in cases of COVID-19. Hyperleukocytosis leads to falsely elevated potassium levels due to cell fragility. Pseudohyperkalemia occurs when elevated potassium is present due to potassium movement out of cells during or after a blood sample is drawn. Pseudohyperkalemia may be suspected when elevated potassium is present in asymptomatic patients with no corresponding electrocardiogram findings. The authors present a case of hyperleukocytosis and pseudohyperkalemia in a patient whose COVID-19 infection unmasked CLL.