A case of allogeneic peripheral blood stem cell in a paroxysmal nocturnal hemoglobinuria patient from a COVID-positive donor: Managing the unpreventable.

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, acquired disease caused by clonal expansion of one or more hematopoietic stem cell lines due to a somatic mutation of the phosphatidylinositol glycan anchor gene. Peripheral blood stem cell (PBSC) harvest is a high-risk procedure and the major concern was regarding the development of COVID infection in the recipient. Herein, we describe an inevitable case of PBSC harvest in a PNH patient who was already started on myeloablation and where the donor became positive 1 day before the harvest. Considering the risk-benefit ratio and the need for elaborate arrangements, the initial plan for bone marrow harvesting was changed to PBSC, and hence, the harvest was performed in a COVID-designated unit. No features of graft versus host disease (GVHD) were observed in the patient. The patient was examined for signs and symptoms of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and there was no evidence of any infection after the procedure. The weekly analysis of the same was done for 1 month after PBSC and the SARS-CoV-2 status remained negative. The authors opine that PBSC from SARS-CoV-2 can be performed safely in some unpreventable situations.