2020
DOI: 10.1136/bcr-2020-237645
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Severe thrombocytopaenia secondary to COVID-19

Abstract: The SARS-CoV-2 infection has caused a pandemic with a case rate of over 290 000 lab-confirmed cases and over 40 000 deaths in the UK. There is little evidence to inform the optimal management of a patient presenting with new or relapsed acute idiopathic thrombocytopaenic purpura with concurrent SARS-CoV-2 infection. We present a case of severe thrombocytopaenia complicated by subdural haematoma and rectal bleed associated with COVID-19. A 67-year-old man, admitted with a non-productive cough and confusion, was… Show more

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Cited by 4 publications
(5 citation 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%
See 1 more Smart Citation
“…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%
“…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%
“…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%