Severe thrombocytopaenia secondary to COVID-19

Patel, Trupesh; Stanton, Noah J.; Gkikas, Ioannis; Triantafyllopoulou, Diana

doi:10.1136/bcr-2020-237645

Cited by 4 publications

(5 citation statements)

References 19 publications

(22 reference statements)

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“…We used these three combinations of glucocorticoid, TP-RA, and cyclosporine for this patient, resulting in platelet count improvement on day 13. A similar notable improvement in platelet count with TP-RA administration for 44 days was also shown in a case of ITP with COVID-19 [ 17 ].…”

Section: Discussionsupporting

confidence: 64%

“…Other various mechanisms of hematologic abnormalities in COVID-19 are: (1) direct infection of the virus to bone marrow and inhibition of the synthesis of blood cells, with cytokine storms also having the potential to disrupt the bone marrow progenitor cells and decrease the platelet count even further; (2) immunothrombosis, which has been one of the most common incidents in coagulopathy abnormalities in COVID-19 that also plays a role in platelet destruction; and (3) aggregation of platelets in vasculature, which may end with microthrombi and platelet consumption [ 16 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

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A full-term pregnant woman with secondary Evans syndrome caused by severe coronavirus disease 2019: a case report

et al. 2021

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Background In this report, we describe a very challenging case of a patient with secondary Evans syndrome caused by severe coronavirus disease 2019 infection in a pregnant full-term woman. Case presentation A 29-year-old full-term pregnant Indonesian woman presented with gross hematuria, dry cough, fever, dyspnea, nausea, anosmia, and fatigue 5 days after confirmation of coronavirus disease 2019 infection. Laboratory examinations showed very severe thrombocytopenia, increased indirect bilirubin, and a positive direct Coombs’ test. From peripheral blood, there was an increased number of spherocytes, which indicated an autoimmune hemolytic process. Antinuclear antibody and anti-double-stranded DNA test results were negative, and her virology serological markers are also negative for human immunodeficiency virus, cytomegalovirus, and hepatitis B and C. Despite aggressive treatment with platelet transfusion, high-dose steroid, and thrombopoietin receptor agonists, the platelet count did not recover, and a speculative cesarean delivery had to be done with a very low platelet count.

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Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

A full-term pregnant woman with secondary Evans syndrome caused by severe coronavirus disease 2019: a case report

et al. 2021

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“…The authors speculated that it was partly immune-mediated (95). Table 4 demonstrated 38 cases of immune thrombocytopenic purpura (ITP) associated with COVID-19 infection, and some of them only had mild or asymptomatic COVID-19 (90,(96)(97)(98)(99)(100)(101)(102)(103)(104)(105)(106)(107)(108)(109)(110)(111)(112)(113). Most of these patients with thrombocytopenia were diagnosed by exclusion and had a favorable response to corticosteroids, IVIG, and even thrombopoietin receptor agonists.…”

Section: Hematological Manifestationsmentioning

confidence: 99%

Autoimmune and Rheumatic Manifestations Associated With COVID-19 in Adults: An Updated Systematic Review

2021

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Background: Numerous cases of the coronavirus disease 2019 (COVID-19) with autoimmune and rheumatic manifestations have been reported. Despite the available reviews that summarized its autoimmune/rheumatic manifestations, a systematic approach is still lacking. Therefore, we conducted a comprehensive systematic review in order to give an overview upon these rare but clinically significant manifestations.Methods: We performed a literature search of PubMed and EMBASE as of October 9, 2020. All articles relevant to either systemic or organ-specific autoimmune and rheumatic manifestations potentially associated with COVID-19 were collected. The reviewed literature were limited to adults ≥18 years.Results: Although most of the existing evidence was based on case reports or case series without a long-term follow-up, a variety of autoimmune/rheumatic manifestations were associated with COVID-19. The manifestations that have a consistent association with COVID-19 include autoimmune cytopenia, cutaneous vasculitis, encephalitis, and Guillain-Barre syndrome. Such association is conflicting as regards to antiphospholipid syndrome, hemophagocytic lymphohistiocytosis, and myasthenia gravis.Conclusion: Our systematic review indicated the potential of the COVID-19 virus to trigger a myriad of autoimmune and rheumatic manifestations, which should be considered amid global efforts to combat COVID-19.

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“…Several additional prospective trials are ongoing to evaluate romiplostim for the treatment of CIT in patients with non-hematologic cancers (phase 2; NCT02052882), gastrointestinal or colorectal cancer (phase 3; NCT03362177), and NSCLC, ovarian cancer, or breast cancer (phase 3; NCT03937154). Although there is little evidence regarding optimal management strategies for thrombocytopenia in the setting of COVID-19, two recent cases have been reported of patients with acute thrombocytopenia secondary to COVID-19 successfully treated with romiplostim (81,82). A 67-year-old male patient developed severe thrombocytopenia complicated by subdural hematoma and rectal bleed, associated with COVID-19.…”

Section: Romiplostimmentioning

confidence: 99%

“…Eltrombopag (another thrombopoietin receptor agonist) was given but stopped as the patient had difficulty swallowing the tablets. Subsequent treatment with romiplostim resulted in gradual recovery to a normal platelet count (81). The second patient was a 6-year-old male with a complex m edical history, including m ild chronic thrombocytopenia.…”

Section: Romiplostimmentioning

confidence: 99%

Improving Outcomes of Chemotherapy: Established and Novel Options for Myeloprotection in the COVID-19 Era

2021

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Chemotherapy-induced damage of hematopoietic stem and progenitor cells (HPSCs) often results in myelosuppression that adversely affects patient health and quality of life. Currently, chemotherapy-induced myelosuppression is managed with chemotherapy dose delays/reductions and lineage-specific supportive care interventions, such as hematopoietic growth factors and blood transfusions. However, the COVID-19 pandemic has created additional challenges for the optimal management of myelosuppression. In this review, we discuss the impact of this side effect on patients treated with myelosuppressive chemotherapy, with a focus on the prevention of myelosuppression in the COVID-19 era. During the COVID-19 pandemic, short-term recommendations on the use of supportive care interventions have been issued with the aim of minimizing the risk of infection, reducing the need for hospitalization, and preserving limited blood supplies. Recently, trilaciclib, an intravenous cyclin-dependent kinase 4 and 6 inhibitor, was approved to decrease the incidence of myelosuppression in adult patients when administered prior to platinum/etoposide-containing or topotecan-containing chemotherapy for extensive-stage small cell lung cancer (ES-SCLC). Approval was based on data from three phase 2 placebo-controlled clinical studies in patients with ES-SCLC, showing that administering trilaciclib prior to chemotherapy significantly reduced multilineage myelosuppression, with patients receiving trilaciclib having fewer chemotherapy dose delays/reductions and myelosuppression/sepsis-related hospitalizations, and less need for supportive care interventions, compared with patients receiving placebo. Several other novel agents are currently in clinical development for the prevention or treatment of multilineage or single-lineage myelosuppression in patients with various tumor types. The availability of treatments that could enable patients to maintain standard-of-care chemotherapy regimens without the need for additional interventions would be valuable to physicians, patients, and health systems.

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Severe thrombocytopaenia secondary to COVID-19

Cited by 4 publications

References 19 publications

A full-term pregnant woman with secondary Evans syndrome caused by severe coronavirus disease 2019: a case report

A full-term pregnant woman with secondary Evans syndrome caused by severe coronavirus disease 2019: a case report

Autoimmune and Rheumatic Manifestations Associated With COVID-19 in Adults: An Updated Systematic Review

Improving Outcomes of Chemotherapy: Established and Novel Options for Myeloprotection in the COVID-19 Era

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