Post-COVID Fatigue: Symptoms and Possible Causes

Q: Post-COVID Fatigue: Symptoms and Possible Causes

Hello： Based on the information you provided regarding your fatigue, several possibilities should be considered： 1. <br>Post-acute sequelae of SARS-CoV-2 infection (PASC)： This may persist for 1-3 months, or even up to six months, but it should gradually improve. <br>2. <br>Anemi

Generalized weakness and fatigue?

Hello, doctor! I was diagnosed in June and isolated at home for seven days.
After recovering, I returned to work normally, but about half a month later, I started to feel noticeably fatigued, dizzy, and generally unwell.
(I had a platelet count of around 79-100, white blood cell count of 2.6, red blood cell count of 3.47, and hemoglobin of 11.9 during health check-ups three years ago and last year.) In mid-July, I also developed gastritis, which has only recently started to improve after seeing both Western and traditional Chinese medicine.
However, due to the dizziness and weakness after my diagnosis, I recently went to the hospital for further tests.
The blood test results were almost the same as before.
The first hospital (hematology department) was concerned about my values and suggested a bone marrow biopsy.
The results indicated that I had a low number of bone marrow cells, and they prescribed steroids, diagnosing me with aplastic anemia.
They mentioned that if the medication was ineffective, I should consider a transplant while I am still young.
I was terrified and felt hopeless, but something didn’t seem right.
My family suggested getting a second opinion, so I went to another hospital for further examination (where I was scheduled for blood tests).
This time, they also tested for ANA and complement levels C3 and C4.
The ANA and C4 were normal, but C3 was low, around 69.
The hematologist at this hospital reviewed the report and said my blood values were acceptable and that I could maintain a normal lifestyle, but since C3 is low, I need to follow up in three months.
Could this possibly indicate a precursor to an immune-related disease (such as rheumatism or lupus)? Aside from weakness and fatigue, I currently have no other symptoms.
I am unsure if I am feeling so easily fatigued due to post-viral syndrome after my diagnosis! For instance, last night I felt extremely tired and weak by 10 PM and fell asleep immediately! Before my diagnosis, my energy and physical condition were generally normal; I could stay up until 11 PM or midnight and even ride a bike or jump rope for 100 repetitions continuously.

WEEE, 20~29 year old female. Ask Date: 2022/08/08

Dr. Lin Zhebin reply Family Medicine

Hello: Based on the information you provided regarding your fatigue, several possibilities should be considered: 1.
Post-acute sequelae of SARS-CoV-2 infection (PASC): This may persist for 1-3 months, or even up to six months, but it should gradually improve.
2.
Anemia: You have a history of being diagnosed with aplastic anemia; however, subsequent follow-ups in hematology suggest that further treatment may not be necessary.
It is advisable to have regular blood tests to monitor your blood cell counts, and if anemia is present, the underlying cause should be identified and treated.
3.
Autoimmune diseases: Blood tests can be conducted to check inflammatory markers such as CRP and ESR.
If systemic lupus erythematosus (SLE) is suspected, in addition to checking ANA and complement levels (C3 and C4, with low C3 being indicative of SLE), tests for Anti-dsDNA and Anti-ENA can be performed.
For rheumatoid diseases, RF and Anti-CCP tests can be conducted.
Additionally, it is important to assess whether you have other symptoms to aid in diagnosis.
4.
Other conditions: Abnormalities in major organ functions or endocrine disorders may also present with fatigue.
In summary, it is recommended that you not only monitor the currently abnormal values but also consider further investigations for other potential causes of fatigue.
If all tests return normal, it is more likely that the fatigue is a result of post-COVID syndrome.

Reply Date: 2022/08/08

More Info

Post-COVID fatigue, often referred to as "Long COVID" or "Post-Acute Sequelae of SARS-CoV-2 infection (PASC)," is a condition that affects many individuals who have recovered from COVID-19. Your experience of fatigue, dizziness, and general malaise following your COVID-19 diagnosis in June aligns with the symptoms reported by many who experience this condition.
Long COVID can manifest in various ways, including persistent fatigue, cognitive difficulties (often termed "brain fog"), sleep disturbances, and physical symptoms such as muscle weakness or joint pain. The symptoms can be debilitating and may significantly impact daily life, as you've described. The fatigue you are experiencing is not merely a result of physical exertion; it can be a complex interplay of physiological, psychological, and immunological factors.

In your case, the history of low blood counts (thrombocytopenia, leukopenia, and anemia) raises some concerns. While these conditions can be related to various underlying issues, including bone marrow disorders or autoimmune diseases, they can also be exacerbated by viral infections, including COVID-19. The fact that your blood tests showed similar results post-COVID suggests that there may be an underlying issue that needs further investigation.
The low C3 complement level you mentioned could indicate a potential immune response issue. Complement proteins play a crucial role in the immune system, and low levels can be associated with autoimmune conditions such as systemic lupus erythematosus (SLE) or other rheumatic diseases. However, it is essential to interpret these results in the context of your overall clinical picture, including symptoms and other laboratory findings.
Given your symptoms and the complexity of your medical history, it would be prudent to follow up with a rheumatologist or an immunologist. They can provide a more comprehensive evaluation to determine if there is an underlying autoimmune condition or if your symptoms are primarily due to post-COVID syndrome.
In terms of managing your fatigue and other symptoms, here are some recommendations:
1. Rest and Recovery: Prioritize rest and allow your body time to recover. Fatigue can be exacerbated by overexertion, so listen to your body and take breaks as needed.

2. Nutrition: Ensure you are consuming a balanced diet rich in vitamins and minerals. Nutrients such as iron, vitamin B12, and folate are essential for red blood cell production and overall energy levels. If you have been diagnosed with anemia, consider discussing dietary adjustments or supplements with your healthcare provider.

3. Hydration: Staying well-hydrated is crucial, especially if you are experiencing gastrointestinal issues. Dehydration can contribute to fatigue and dizziness.

4. Physical Activity: Engage in light physical activity as tolerated. Gentle exercises, such as walking or stretching, can help improve energy levels and overall well-being. However, avoid pushing yourself too hard, as this can lead to increased fatigue.

5. Mental Health Support: Consider seeking support for any emotional or psychological distress you may be experiencing. Mental health can significantly impact physical health, and addressing feelings of anxiety or depression can be beneficial.

6. Follow-Up Care: Keep regular follow-up appointments with your healthcare providers to monitor your blood counts and any potential autoimmune markers. This will help ensure that any emerging issues are addressed promptly.

In conclusion, while your symptoms may be related to post-COVID fatigue, the underlying blood abnormalities warrant further investigation. Collaborating with your healthcare team will be essential in managing your health and ensuring that any potential conditions are identified and treated appropriately. Remember, recovery from COVID-19 can be a gradual process, and it is essential to be patient with yourself as you navigate this journey.

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