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2020 ; 112
(6
): 883-888
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Immune thrombocytopenia in a patient with COVID-19
#MMPMID32677007
Deruelle E
; Ben Hadj Salem O
; Sep Hieng S
; Pichereau C
; Outin H
; Jamme M
Int J Hematol
2020[Dec]; 112
(6
): 883-888
PMID32677007
show ga
This case report describes immune thrombocytopenic purpura in a 41-year-old man
hospitalized in the intensive-care unit for COVID-19, 13 days after the onset of
COVID-19 symptoms with respiratory failure at admission. Acute respiratory
distress syndrome was treated with, among other drugs, low-molecular-weight
heparin. On day 8, his platelet count began descending rapidly. On day 10,
heparin treatment was replaced by danaparoid sodium, but by day 13, the continued
low platelet count made a diagnosis of heparin-induced thrombocytopenia unlikely.
Normocytic nonregenerative anemia gradually developed. On day 13, a bone marrow
aspiration showed numerous megakaryocytes and a few signs of hemophagocytosis.
Corticosteroids were introduced on day 14, and platelets began rising after
3 days and then fell again on day 19. Intravenous immunoglobulin (IV Ig) was then
administered. Two days later, the platelet count returned to normal. The immune
cause was confirmed by ruling out the differential diagnoses and the excellent
and rapid response to intravenous immunoglobulins. Finally, the patient's
respiratory state improved. He was discharged to a respiratory rehabilitation
unit on day 38. Our case suggests that an immunological cause should be
considered in patients with thrombocytopenia during COVID-19.
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