Coronavirus disease 2019 (COVID-19) in a pregnant women with treatment resistance thrombocytopenic purpura with and suspicion to HELLP syndrome: a case report

Abstract

Background Coronavirus disease 2019 (COVID-19) still is a global emergency. According to the studies, pregnant women are of the at risk populations and any underlying disease(s) might even worsen their condition. The aim of this study is reporting a complex case of immune thrombocytopenic purpura (ITP) during pregnancy who has been diagnosed with COVID-19 as well as suspicion of HELLP syndrome. Case presentation A 24-year-old woman with a platelet count of 6000/mL and resistance to conventional therapies was referred. A day after starting 0.5 g/day of methylprednisolone for her, fever and a decrease in SpO2 presented. According to the paraclinical investigations, COVID-19 was diagnosed and the conventional COVID-19 treatments started for her (the methylprednisolone pulse stopped). Due to the increased liver enzymes and low platelet count, with suspicion of HELLP syndrome, cesarean section surgery was performed which resulted in a healthy neonate. Then, the methylprednisolone pulse was restarted for and she developed an increase in the platelet count. Conclusion It is not clear how COVID-19 and pregnancy affected the patient’s condition and the underlying disease; however, it seems the delivery and/or restarting the methylprednisolone pulses caused improvement in her condition.

COVID-19: A Cause of HELLP Syndrome? A Case Report

“…This case is different from the cases previously presented in the literature. 5 , 21 , 22 Because both diseases (COVID-19, HELLP) have a typical clinical course proven by laboratory findings and it is a case in which differential diagnostic diseases are ruled out with comprehensive screening.…”

High-risk pregnant women’s experiences of the receiving prenatal care in COVID-19 pandemic: a qualitative study

“…COVID-19 in pregnancy has been associated with complications such as premature rupture of the membranes (PPROM) and preterm delivery [ 12 , 13 ], fetal distress, and fetal growth restriction as a result of maternal hypoxia. The rate of cesarean section is also reported to be 96.4%, possibly indicating that iatrogenic reasons (fear of obstetrics) can also be a factor [ 14 , 15 ]. This has resulted in an increase in the number of pregnant women admitted to the ICU during the COVID-19 pandemic [ 16 ].…”

“…So far, few quantitative studies have been conducted on the psychological effects of coronavirus outbreaks in the general population [ 22 – 24 ] and pregnant women [ 15 , 25 ], and recommendations for receiving remote prenatal care have reduced referrals for prenatal care [ 26 ]. However, no qualitative studies have been conducted to explain the perceptions and experiences of women with high-risk pregnancies receiving maternity care under these conditions.…”

HELLP Syndrome and COVID-19; association or accident: A case series

“…Hemolysis with elevated liver enzymes, hemolysis and low platelet count (HELLP) syndrome is a dangerous obstetric disease which leads on to activation of the general inflammatory cascade progressing into extensive damage to the endothelium along with thrombocytopenia. [ 7 ] It is associated with increased maternal and fetal complications. [ 8 ]…”