COVID-19 has impacted hundreds of millions of people globally, a relatively large proportion of whom continue to suffer from ongoing, sometime debilitating symptoms. This phenomenon, termed “long COVID,” is difficult to diagnose and manage because of a paucity of objective findings and despite the abundance of descriptive data published so far. In this review, we aimed to describe the common manifestations of long COVID, diagnostic and management challenges, and address specific aspects in hematologic patients.

1.
WHO
.
WHO Coronavirus disease (COVID-19) dashboard (live) [Internet]
[cited 2021 Feb 27]. Available from: https://covid19.who.int/.
2.
World Health Organization
.
A clinical case definition of post COVID-19 condition by a Delphi consensus
.
2021 Oct
. Available from: https://www.who.int/publications/i/item/WHO-2019-nCoV-Post_COVID-19_condition-Clinical_case_definition-20211.
3.
Michelen
M
,
Manoharan
L
,
Elkheir
N
,
Cheng
V
,
Dagens
A
,
Hastie
C
,
Characterising long COVID: a living systematic review
.
BMJ Glob Heal
.
2021
;
6
(
9
):
1
12
.
4.
Sudre
CH
,
Murray
B
,
Varsavsky
T
,
Graham
MS
,
Penfold
RS
,
Bowyer
RC
,
Attributes and predictors of long COVID
.
Nat Med
.
2021
;
27
(
4
):
626
31
.
5.
Yelin
D
,
Margalit
I
,
Yahav
D
,
Runold
M
,
Bruchfeld
J
.
Long COVID-19: it’s not over until?
Clin Microbiol Infect
.
2021
;
27
(
4
):
506
8
.
6.
Hickie
I
,
Davenport
T
,
Wakefield
D
,
Vollmer-Conna
U
,
Cameron
B
,
Vernon
SD
,
Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: prospective cohort study
.
Br Med J
.
2006
;
333
(
7568
):
575
.
7.
Lam
MHB
,
Wing
YK
,
Yu
MWM
,
Leung
CM
,
Ma
RCW
,
Kong
APS
,
Mental morbidities and chronic fatigue in severe acute respiratory syndrome survivors long-term follow-up
.
Arch Intern Med
.
2009
;
169
(
22
):
2142
7
.
8.
Scoppettuolo
P
,
Borrelli
S
,
Naeije
G
.
Neurological involvement in SARS-CoV-2 infection: a clinical systematic review
.
Brain Behav Immun Heal
.
2020
;
5
:
100094
.
9.
Sanghvi
SK
,
Schwarzman
LS
,
Nazir
NT
.
Cardiac MRI and myocardial injury in COVID-19: diagnosis, risk stratification and prognosis
.
Diagnostics
.
2021
;
11
(
1
):
130
.
10.
Pelle
MC
,
Tassone
B
,
Ricchio
M
,
Mazzitelli
M
,
Davoli
C
,
Procopio
G
,
Late-onset myocardial infarction and autoimmune haemolytic anaemia in a COVID-19 patient without respiratory symptoms, concomitant with a paradoxical increase in inflammatory markers: a case report
.
J Med Case Rep
.
2020
;
14
(
1
):
246
.
11.
Bhattacharjee
S
,
Banerjee
M
.
Immune thrombocytopenia secondary to COVID-19: a systematic review
.
SN Compr Clin Med
.
2020
;
14
(
11
):
2048
9
. .
12.
Marazuela
M
,
Giustina
A
,
Puig-Domingo
M
.
Endocrine and metabolic aspects of the COVID-19 pandemic
.
Rev Endocr Metab Disord
.
2020
;
21
(
4
):
495
507
.
13.
Nehme
M
,
Braillard
O
,
Chappuis
F
,
Courvoisier
DS
,
Guessous
I
.
Prevalence of symptoms more than seven months after diagnosis of symptomatic COVID-19 in an outpatient setting
.
Ann Intern Med
.
2021
;
174
(
9
):
1252
60
.
14.
Huang
C
,
Huang
L
,
Wang
Y
,
Li
X
,
Ren
L
,
Gu
X
,
Articles 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study
.
Lancet
.
2021
;
10270
(
9
):
220
32
.
15.
Antonelli
M
,
Penfold
RS
,
Merino
J
,
Sudre
CH
,
Molteni
E
,
Berry
S
,
Risk factors and disease profile of post-vaccination SARS-CoV-2 infection in UK users of the COVID symptom study app: a prospective, community-based, nested, case-control study
.
Lancet Infect Dis
.
2022
;
22
(
1
):
43
55
.
16.
Zhang
X
,
Wang
F
,
Shen
Y
,
Zhang
X
,
Cen
Y
,
Wang
B
,
Symptoms and health outcomes among survivors of COVID-19 infection 1 year after discharge from hospitals in Wuhan, China
.
JAMA Netw Open
.
2021 Sep
;
4
(
9
):
e2127403
.
17.
Bai
F
,
Tomasoni
D
,
Falcinella
C
,
Barbanotti
D
,
Castoldi
R
,
Mulè
G
,
Female gender is associated with “long COVID” syndrome: a prospective cohort study
.
Clin Microbiol Infect
.
2021
;
S1198–743X
(
21
)
00629
7
.
18.
Boscolo-Rizzo
P
,
Guida
F
,
Polesel
J
,
Marcuzzo
AV
,
Capriotti
V
,
D’Alessandro
A
,
Sequelae in adults at 12 months after mild-to-moderate coronavirus disease 2019 (COVID-19)
.
Int Forum Allergy Rhinol
.
2021
;
11
(
12
):
1685
8
.
19.
Lombardo
MDM
,
Foppiani
A
,
Peretti
GM
,
Mangiavini
L
,
Battezzati
A
,
Bertoli
S
,
Long term COVID-19 complications in inpatients and outpatients: a One-Year Follow Up Cohort Study
.
SSRN Electron J
.
2021
;
8
:
1
8
.
20.
Tenforde
MW
,
Kim
SS
,
Lindsell
CJ
,
Billig Rose
E
,
Shapiro
NI
,
Files
DC
,
Symptom duration and risk factors for delayed return to usual health among outpatients with COVID-19 in a multistate health care systems network: United States, March–June 2020
.
MMWR Morb Mortal Wkly Rep
.
2020
;
69
:
993
8
.
21.
Munblit
D
,
Bobkova
P
,
Spiridonova
E
,
Shikhaleva
A
,
Gamirova
A
,
Blyuss
O
,
Incidence and risk factors for persistent symptoms in adults previously hospitalized for COVID-19
.
Clin Exp Allergy
.
2021
;
51
(
9
):
1107
20
.
22.
Terpos
E
,
Ntanasis-Stathopoulos
I
,
Elalamy
I
,
Kastritis
E
,
Sergentanis
TN
,
Politou
M
,
Hematological findings and complications of COVID-19
.
Am J Hematol
.
2020
;
95
(
7
):
834
47
.
23.
Kuter
DJ
.
Exacerbation of immune thrombocytopenia following COVID-19 vaccination
.
Br J Haematol
.
2021 Nov
;
195
(
3
):
365
70
. .
24.
Serrano
C
,
Español
I
,
Cascales
A
,
Moraleda
JM
,
Kalita
P
,
Laishram
D
,
Secondary hemophagocytic lymphohistiocytosis in post-COVID-19 patients: a report of two cases
.
SN Compr Clin Med
.
2021
;
13
(
12
):
2389
92
.
25.
Pretorius
E
,
Vlok
M
,
Venter
C
,
Bezuidenhout
JA
,
Laubscher
GJ
,
Steenkamp
J
,
Persistent clotting protein pathology in long COVID/post-acute sequelae of COVID-19 (PASC) is accompanied by increased levels of antiplasmin
.
Cardiovasc Diabetol
.
2021
;
20
(
1
):
1
18
.
26.
Zuin
M
,
Rigatelli
G
,
Zuliani
G
,
Roncon
L
.
The risk of thrombosis after acute-COVID-19 infection
.
QJM An Int J Med
.
2021 Sep
;
114
(
9
):
619
20
. .
27.
Havervall
S
,
Rosell
A
,
Phillipson
M
,
Mangsbo
SM
,
Nilsson
P
,
Hober
S
,
Symptoms and functional impairment assessed 8 months after mild COVID-19 among health care workers
.
Jama
.
2021
;
11
:
11
3
.
28.
Peghin
M
,
Palese
A
,
Venturini
M
,
De Martino
M
,
Gerussi
V
,
Graziano
E
,
Post-COVID-19 symptoms 6 months after acute infection among hospitalized and non-hospitalized patients
.
Clin Microbiol Infect
.
2021 Jun
;
S1198–743X
(
21
)
00281
0
.
29.
Munblit
D
,
Bobkova
P
,
Spiridonova
E
,
Shikhaleva
A
,
Gamirova
A
,
Blyuss
O
,
Risk factors for long-term consequences of COVID-19 in hospitalised adults in Moscow using the ISARIC Global follow-up protocol: StopCOVID cohort study
.
medRxiv
.
2021
;
2021
. 02.17.21251895.
30.
Huang
L
,
Yao
Q
,
Gu
X
,
Wang
Q
,
Ren
L
,
Wang
Y
,
1-year outcomes in hospital survivors with COVID-19: a longitudinal cohort study
.
Lancet
.
2021
;
398
(
10302
):
747
58
.
31.
Crook
H
,
Raza
S
,
Nowell
J
,
Young
M
,
Edison
P
.
Long covid: mechanisms, risk factors, and management
.
BMJ
.
2021
;
374
:
1
18
.
32.
Fogarty
H
,
Townsend
L
,
Morrin
H
,
Ahmad
A
,
Comerford
C
,
Karampini
E
,
Persistent endotheliopathy in the pathogenesis of long COVID syndrome
.
J Thromb Haemost
.
2021 Oct
;
19
(
10
):
2546
53
.
33.
Reuken
PA
,
Stallmach
A
,
Pletz
MW
,
Brandt
C
,
Andreas
N
,
Hahnfeld
S
,
Severe clinical relapse in an immunocompromised host with persistent SARS-CoV-2 infection
.
Leukemia
.
2021
;
35
(
3
):
920
3
.
34.
Helleberg
M
,
Niemann
CU
,
Moestrup
KS
,
Kirk
O
,
Lebech
A-M
,
Lane
C
,
Persistent COVID-19 in an immunocompromised patient temporarily responsive to two courses of remdesivir therapy
.
J Infect Dis
.
2020 Sep
;
222
(
7
):
1103
7
.
35.
Truong
TT
,
Ryutov
A
,
Pandey
U
,
Yee
R
,
Goldberg
L
,
Bhojwani
D
,
Persistent SARS-CoV-2 infection and increasing viral variants in children and young adults with impaired humoral immunity
.
medRxiv Prepr Serv Heal Sci
.
2021 Mar
;
2021
. 02.27.21252099.
36.
Yahav
D
,
Yelin
D
,
Eckerle
I
,
Eberhardt
CS
,
Wang
J
,
Cao
B
,
Definitions for coronavirus disease 2019 reinfection, relapse and PCR re-positivity
.
Clin Microbiol Infect
.
2020
;
27
:
315
8
.
37.
Liu
K
,
Zhang
W
,
Yang
Y
,
Zhang
J
,
Li
Y
,
Chen
Y
.
Respiratory rehabilitation in elderly patients with COVID-19: a randomized controlled study
.
Complement Ther Clin Pract
.
2020
;
39
:
101166
.
38.
Gloeckl
R
,
Leitl
D
,
Jarosch
I
,
Schneeberger
T
,
Nell
C
,
Stenzel
N
,
Benefits of pulmonary rehabilitation in COVID-19: a prospective observational cohort study
.
ERJ Open Res
.
2021
;
7
(
2
):
00108
2021
.
39.
Goodwin
VA
,
Allan
L
,
Bethel
A
,
Cowley
A
,
Cross
JL
,
Day
J
,
Rehabilitation to enable recovery from COVID-19: a rapid systematic review
.
Physiotherapy
.
2021 Jun
;
111
:
4
22
.
40.
Jennings
G
,
Monaghan
A
,
Xue
F
,
Mockler
D
,
Romero-Ortuño
R
.
A systematic review of persistent symptoms and residual abnormal functioning following acute COVID-19: ongoing symptomatic phase vs. post-COVID-19 syndrome
.
medRxiv
.
2021
;
10
(
24
):
5913
.
41.
Cassar
MP
,
Tunnicliffe
EM
,
Petousi
N
,
Lewandowski
AJ
,
Xie
C
,
Mahmod
M
,
Symptom persistence despite improvement in cardiopulmonary health: insights from longitudinal CMR, CPET and lung function testing post-COVID-19
.
EClinicalMedicine
.
2021
;
41
:
101159
.
42.
Halle
M
,
Bloch
W
,
Niess
AM
,
Predel
H
,
Reinsberger
C
,
Scharhag
J
,
Exercise and sports after COVID 19: guidance from a clinical perspective
.
Transl Sport Med
.
2021
;
4
(
3
):
310
8
.
43.
Małek
ŁA
,
Marczak
M
,
Miłosz-Wieczorek
B
,
Konopka
M
,
Braksator
W
,
Drygas
W
,
Cardiac involvement in consecutive elite athletes recovered from Covid-19: a magnetic resonance study
.
J Magn Reson Imaging
.
2021
;
53
(
6
):
1723
9
.
44.
Becker
JH
,
Lin
JJ
,
Doernberg
M
,
Stone
K
,
Navis
A
,
Festa
JR
,
Assessment of cognitive function in patients after COVID-19 infection
.
JAMA Netw Open
.
2021
;
4
(
10
):
8
11
.
45.
Watters
K
,
Marks
TS
,
Edwards
DF
,
Skidmore
ER
,
Giles
GM
.
A framework for addressing clients' functional cognitive deficits after COVID-19
.
Am J Occup Ther
.
2021 Jul–Aug
;
75
(
Suppl 1
):
7511347010p1
. .
46.
Webster
KE
,
OʼByrne
L
,
MacKeith
S
,
Philpott
C
,
Hopkins
C
,
Burton
MJ
.
Interventions for the prevention of persistent post-COVID-19 olfactory dysfunction
.
Cochrane database Syst Rev
.
2021
;
7
:
CD013877
. .
47.
Addison
AB
,
Wong
B
,
Ahmed
T
,
Macchi
A
,
Konstantinidis
I
,
Huart
C
,
Clinical Olfactory Working Group consensus statement on the treatment of postinfectious olfactory dysfunction
.
J Allergy Clin Immunol
.
2021
;
147
(
5
):
1704
19
.
48.
Abdelalim
AA
,
Mohamady
AA
,
Elsayed
RA
,
Elawady
MA
,
Ghallab
AF
.
Corticosteroid nasal spray for recovery of smell sensation in COVID-19 patients: a randomized controlled trial
.
Am J Otolaryngol
.
2021 Mar–Apr
;
42
(
2
):
102884
. .
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