BACKGROUND:COVID-19 is a newly emerging disease that is not yet fully understood. It is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel virus that is easily transmitted from human to human through the respiratory route. Usually, it presents with fever, headache, fatigue accompanied by respiratory symptoms like cough and dyspnea, and other systemic involvements. Chronic lymphocytic leukemia (CLL) is a common lymphoproliferative neoplasm characterized by absolute lymphocytosis and demonstration of clonality unlike other causes of lymphocytosis. Patients with CLL are considered immunocompromised because of impaired humoral immunity (mainly) and cellular immunity. Therefore, they are vulnerable to various infections including COVID-19. Little is known about the COVID-19 infection when it unmasks CLL. CASE REPORT:A 49-year-old man with no significant previous illnesses, and an unremarkable family history, presented with a moderate COVID-19 infection. He initially presented to the emergency department with fever and mild shortness of breath. A complete blood count showed a high white blood cell count with absolute lymphocytosis. Flow cytometry revealed the clonality of the lymphocytes confirming the diagnosis of CLL. Despite having CLL, he developed a moderate COVID-19 infection and recovered in a few days. To the best of our knowledge, this is the first report of CLL, which presented with a COVID-19 infection as the initial presentation. CONCLUSIONS:Lymphocytosis is an unexpected finding in patients diagnosed with COVID-19 infection and the elevated lymphocytes may be indicative of other conditions. Secondary causes of lymphocytosis like malignancy or other infections should be considered in these cases.

Severe COVID‐19 infection is associated with significant stress and marked immune response that can affect many organs and precipitate DKA, pancreatitis, and acute renal injury, which might be permanent.

Iron deficiency anemia is a common cause of anemia that develops when body stores of an iron drop too low to support normal red blood cell (RBC) production. Inadequate dietary iron, impaired iron absorption, bleeding, or loss of body iron in the urine may be the cause. Iron is a key part of red blood cells. Without iron, the blood cannot carry oxygen effectively. Our body normally gets iron through the diet. It also reuses iron from old red blood cells. A little is known about the association between iron deficiency anemia and neutropenia. Here we report a 44-year-old female who presented with iron deficiency anemia and found to have neutropenia recovered after she received intravenous (IV) iron therapy. However, she did not develop any serious infections during the neutropenia and responded to iron therapy.

The association between the COVID vaccine and MCD is temporal and by exclusion, and it is not fully established, but it should be considered in postvvaccine MCD.

Idiopathic thrombocytopenic purpura (ITP) is a disease in which the immune system attacks platelets and decreases their number, which increases the patient's risk of bleeding. ITP is diagnosed by exclusion and usually manifests as acute disease. It is self-limiting in pediatric patients, while it tends to be a chronic disease in adults. Treatment of ITP focuses on maintaining a sufficient platelet count to decrease the risk of bleeding rather than normalize the platelet count. Most patients respond to first-line treatments, such as steroids and intravenous immunoglobulin (IVIG). However, some cases can become steroid-dependent or unresponsive to first-line therapy, in which case, second-line therapy is required to control symptoms or the platelet count. Second-line therapy includes either rituximab or a thrombopoietin receptor agonist (eltrombopag, romiplostim). In a few cases, when second-line therapy alone is insufficient to control the disease, a combination of therapies is required to control the symptoms and platelet count. Here, we present a case of a 41-year-old man with refractory ITP who did not respond to first-line treatment with either steroids or IVIG or a combination of the two, and also did not respond to eltrombopag alone and required a combination of eltrombopag and rituximab to control his disease.

Iron deficiency anemia is the most common type of anemia, and it occurs when the human body does not have enough of the mineral iron (https://www.healthline.com/health/iron-deficiency-anemia#diagnosis). Iron deficiency anemia is caused by blood loss, insufficient dietary intake, or poor absorption of iron from food. Sources of blood loss can include heavy periods, childbirth, uterine fibroids, stomach ulcers, colon cancer, and urinary tract bleeding (https://www.nhlbi.nih.gov/health-topics/iron-deficiency-anemia). Poor absorption of iron from food may occur as a result of an intestinal disorder such as inflammatory bowel disease or celiac disease, or surgery such as a gastric bypass (https://www.who.int/nutrition/topics/ida/en/). Little is known about the association between iron deficiency anemia and lymphocytopenia. Here, we report on a 17-year-old female who presented with iron deficiency anemia and was found to have lymphopenia. She recovered after having received intravenous iron therapy.