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2020 ; 12
(7
): e9083
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Immune Thrombocytopenia Purpura Secondary to COVID-19
#MMPMID32676257
Bennett J
; Brown C
; Rouse M
; Hoffmann M
; Ye Z
Cureus
2020[Jul]; 12
(7
): e9083
PMID32676257
show ga
A 73-year-old female with past medical history of essential hypertension,
hyperlipidemia, seasonal allergies, and chronic back pain presented to the
hospital with complaints of headaches, fevers, fatigue, generalized body aches,
shortness of breath, and diarrhea. Initial complete blood count was remarkable
for leukopenia with an absolute lymph count of 0.60 K/µL and severe
thrombocytopenia (platelet count < 3 K/µL). She was tested for COVID-19 via
nasopharyngeal swab polymerase chain reaction (PCR) testing and found positive.
Additional labs showed an elevated D-dimer, C-reactive protein, fibrinogen, and
lactate dehydrogenase. Vitamin B12 and folate levels were obtained and found to
be normal. Peripheral smear showed no schistocytes or additional hematologic
abnormalities apart from thrombocytopenia. The patient was transfused one unit
of platelets with no improvement in platelet count. Fibrinogen count was obtained
and found in normal range at 458 mg/dL. Prothrombin time (PT), activated partial
thromboplastin time (aPTT), and international normalized ratio (INR) were all
found to be normal. Immune thrombocytopenia purpura (ITP) was suspected and
intravenous immunoglobulin (IVIG) was administered at a dose of 1 g/kg/day for
two doses. By day 4, the patient had marked response to treatment with platelet
recovery to 105 K/µL and subsequently discharged by day 5 with complete
resolution of symptoms and platelet count of 146 K/µL. Twenty-eight days after
discharge, she presented to hematology clinic with platelet count of 8
K/µL. Repeat nasopharyngeal swab PCR COVID testing was negative and she was
treated with IVIG and pulse dexamethasone with prompt response, confirming
suspicion of underlying, undiagnosed ITP prior to COVID infection.