Immune Thrombocytopenia in a Very Elderly Patient With Covid-19

Hindilerden, Fehmi; Yonal-Hindilerden, Ipek; Şenoğlu, Sevtap; Kart-Yasar, Kadriye

doi:10.3389/fmed.2020.00404

Cited by 14 publications

(13 citation statements)

References 15 publications

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“…Regarding AIC cases reported after or concomitant to COVID-19 infection/pneumonia ( Table 4 ), the most represented is ITP, with 23 patients (mostly case reports) that developed COVID-19-associated acute/severe thrombocytopenia. This cytopenia was not present before infection and was different from the frequently observed mild thrombocytopenia accompanying COVID-19 ( 14 , 27 – 33 ). All cases resolved with steroids and/or IvIg with the exception of one patient who died for intra-ventricular hemorrhage and pulmonary embolism/pneumonia ( 27 ).…”

Section: Resultscontrasting

confidence: 73%

Are Patients With Autoimmune Cytopenias at Higher Risk of COVID-19 Pneumonia? The Experience of a Reference Center in Northern Italy and Review of the Literature

2021

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During COVID-19 pandemic the care of onco-hematologic and autoimmune patients has raised the question whether they are at higher risk of infection and/or worse outcome. Here, we describe the clinical course of COVID-19 pneumonia in patients with autoimmune cytopenias (AIC) regularly followed at a reference center in Northern Italy. The study period started from COVID-19 outbreak (February 22, 2020) until the time of writing. Moreover, we provide a review of the literature, showing that most cases reported so far are AIC developed during or secondary to COVID-19 infection. At variance, data about AIC pre-existing to COVID infection are scanty. The 4 patients here described (2 autoimmune hemolytic anemias, AIHA, 1 Evans syndrome, and 1 immune thrombocytopenia) with COVID-19 pneumonia belong to a large cohort of 500 AIC patients, making this study nearly population-based. The observed frequency (4/501; 0.7%) is only slightly superior to that of the general population admitted to hospital/intensive care unit (0.28/0.03%, respectively) in Lombardy in the same period of observation. All cases occurred between March 21 and 25, whilst no more AIC were recorded later on. Although different in intensity of care needed, all patients recovered from COVID-19 pneumonia, with apparently no detrimental effect of previous/current immunomodulatory treatments. AIHA relapse occurred in two patients, but promptly responded to therapy. With limitations due to sample size, these results suggest a favorable outcome and a lower-than-expected incidence of COVID-19 pneumonia in patients with previously diagnosed AIC, and allow speculating that immunomodulatory drugs used for AIC may play a beneficial rather than a harmful effect on COVID-19 infection.

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Section: Resultscontrasting

confidence: 73%

Are Patients With Autoimmune Cytopenias at Higher Risk of COVID-19 Pneumonia? The Experience of a Reference Center in Northern Italy and Review of the Literature

2021

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“…Past history of venous thrombosis in this patient negates the possibility of secondary APLS due to COVID-19 [ 34 ]. Due to a possible association of ITP with multiple myeloma (MM) [ 45 ], serum protein electrophoresis has been done in few studies [ 8 , 9 ]. It is justified to rule out MM, especially for elderly patients with high index of clinical suspicion.…”

Section: Discussionmentioning

confidence: 99%

Immune Thrombocytopenia Secondary to COVID-19: a Systematic Review

Bhattacharjee

Banerjee

2020

SN Compr. Clin. Med.

262

325

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Immune thrombocytopenia, often known as immune thrombocytopenic purpura (ITP), has emerged as an important complication of COVID-19. A systematic review was done to analyze the clinical profile and outcomes in a total of 45 cases of new-onset ITP in COVID-19 patients described in literature until date. A comprehensive approach is essential for diagnosing COVID-19associated ITP after excluding several concomitant factors that can cause thrombocytopenia in COVID-19. Majority of ITP cases (71%) were found to be elderly (> 50 years) and 75% cases had moderate-to-severe COVID-19. Three patients (7%) were in the pediatric age group. Reports of ITP in asymptomatic COVID-19 patients (7%) underscore the need for COVID-19 testing in newly diagnosed patients with ITP irrespective of COVID-19 symptoms amid this pandemic. ITP onset occurred in 20% cases 3 weeks after onset of COVID-19 symptoms, with many reports after clinical recovery. SARS-CoV-2-mediated immune thrombocytopenia can be attributed to the underlying immune dysregulation, susceptibility mutations in SOCS 1, and other mechanisms, including molecular mimicry, cryptic antigen expression, and epitope spreading. No bleeding manifestations were reported in 31% cases at diagnosis. Severe life-threatening bleeding was uncommon. One case of mortality was attributed to intracranial hemorrhage. Secondary Evans syndrome was diagnosed in one case. Good initial response to short course of glucocorticoids and intravenous immunoglobulin has been found with the exception of delayed lag response in one case. Thrombopoietin receptor agonist usage as a second-line agent has been noted in few cases for short duration with no adverse events. In the relatively short follow-up period, four relapses of ITP were found.

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“…However, potential immune-mediated platelet destruction needs to be considered in the light of reports of post-COVID ITP and TTP. 76 , 77 The likely mechanism in this case is molecular mimicry between the antigens of SARS-CoV-2 and platelet glycoproteins. However, sequence homology between SARS-CoV-2 proteins and platelet antigens is still to be identified.…”

Section: Postulated Mechanisms Of Hematological Abnormalities In Covimentioning

confidence: 97%

Hematological Abnormalities in COVID-19: A Narrative Review

Rahman

Niloofa

Jayarajah

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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COVID-19 is caused by SARS-CoV-2. Although pulmonary manifestations have been identified as the major symptoms, several hematological abnormalities have also been identified. This review summarizes the reported hematological abnormalities (changes in platelet, white blood cell, and hemoglobin, and coagulation/fibrinolytic alterations), explores their patho-mechanisms, and discusses its management. Common hematological abnormalities in COVID-19 are lymphopenia, thrombocytopenia, and elevated D-dimer levels. These alterations are significantly more common/prominent in patients with severe COVID-19 disease, and thus may serve as a possible biomarker for those needing hospitalization and intensive care unit care. Close attention needs to be paid to coagulation abnormalities, and steps should be taken to prevent these occurring or to mitigate their harmful effects. The effect of COVID-19 in patients with hematological abnormalities and recognized hematological drug toxicities of therapies for COVID-19 are also outlined.

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Immune Thrombocytopenia in a Very Elderly Patient With Covid-19

Cited by 14 publications

References 15 publications

Are Patients With Autoimmune Cytopenias at Higher Risk of COVID-19 Pneumonia? The Experience of a Reference Center in Northern Italy and Review of the Literature

Are Patients With Autoimmune Cytopenias at Higher Risk of COVID-19 Pneumonia? The Experience of a Reference Center in Northern Italy and Review of the Literature

Immune Thrombocytopenia Secondary to COVID-19: a Systematic Review

Hematological Abnormalities in COVID-19: A Narrative Review

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