Severe Thrombocytopenia as a Manifestation of COVID-19 Infection

Mocan, Mihaela; Chiorescu, Roxana Mihaela; Tirnovan, Andrada; Buksa, Botond Sandor; Fărcăş, Anca Daniela

doi:10.3390/jcm11041088

Cited by 7 publications

(5 citation statements)

References 31 publications

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“…In our study, we excluded patients with COVID-19 to match the inclusion criteria of a previous similar study by Han,et al [6]. This was also because COVID-19 has been linked to thrombocytopenia of varying degrees, as reported in previous studies, case reports, and case series [19,[31][32][33][34][35][36][37][38]. Thus, we wanted to exclude this condition as a potential confounding factor.…”

Section: Discussionmentioning

confidence: 99%

Linezolid-Associated Thrombocytopenia: Assessment of Risk Factors in Patients without Hemato-Oncologic Diseases

Thabit,

Alghamdi,

Alsaeed

et al. 2024

JCM

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Background: Linezolid is used for Gram-positive bacterial infections. Thrombocytopenia is one of its main adverse effects resulting from myelosuppression. Several studies have assessed risk factors that may increase the risk of this adverse effect. However, most studies included patients with hemato-oncologic diseases, which may confound such assessments. This study aimed to investigate risk factors for linezolid-associated thrombocytopenia in patients without hemato-oncologic diseases. Methods: This was a multicenter retrospective case-control study of adult patients treated with linezolid twice daily for ≥3 days. Patients with hemato-oncologic diseases, active dengue fever, active COVID-19, baseline platelet count <100 × 103/mm3, concurrent therapy with trimethoprim/sulfamethoxazole or valproic acid, and a recent platelet transfusion within 7 days were excluded. Thrombocytopenia was defined as a drop in platelet count below 100 × 103/mm3. Results: Out of 158 evaluated patients, 33 developed thrombocytopenia, indicating an incidence rate of 20.9%. Of all the risk factors assessed, creatinine clearance of <60 mL/min and bacteremia/infective endocarditis were significantly associated with linezolid-associated thrombocytopenia (adjusted odds ratios, 3.25 and 5.95; 95% CI 1.12–9.45 and 1.23–28.66; p = 0.031 and 0.026, respectively). End of therapy platelet counts were significantly lower in the cases than in the controls (79 vs. 243 × 103/mm3; p < 0.001). Similarly, the percentage of platelet count change was significantly different (−55.1% vs. −10.2%; p < 0.001). Conclusions: In our study, the incidence rate of linezolid-associated thrombocytopenia was 20.9%, and we found that patients with renal impairment and bacteremia may need close monitoring of platelet counts. Prospective studies are warranted to evaluate the potential need for renal dose adjustment.

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Section: Discussionmentioning

confidence: 99%

Linezolid-Associated Thrombocytopenia: Assessment of Risk Factors in Patients without Hemato-Oncologic Diseases

Thabit,

Alghamdi,

Alsaeed

et al. 2024

JCM

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“…Platelet transfusion is often considered in patients with severe thrombocytopenia to prevent bleeding complications [ 19 ]. Our study found a significant association between platelet transfusion and the degree of thrombocytopenia, organ dysfunction, shock, and third space loss [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical and Etiological Profile of Acute Undifferentiated Fever With Thrombocytopenia in an Emergency Department

Dev,

Kumar,

Kumar

et al. 2023

Cureus

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Introduction: Acute undifferentiated fever with thrombocytopenia is a common and challenging clinical presentation encountered in the emergency departments of tertiary care centers, particularly in tropical regions, often requiring prompt evaluation and management. The study aimed to explore the clinical and etiological profile of acute undifferentiated fever with thrombocytopenia in the Emergency Department of Indira Gandhi Institute of Medical Sciences, Patna. It investigates factors associated with patient outcomes and compares platelet transfusion requirements among different etiological groups. Methods: In this cross-sectional observational study, 350 patients with acute undifferentiated fever with thrombocytopenia were analyzed for one year from October '21 to September '22. Pre-existing chronic infectious diseases, liver cirrhosis, and autoimmune conditions were excluded. Results: Thrombocytopenia was observed in all patients, with 65% having platelet counts below 50,000/µL. Associations were found between the degree of thrombocytopenia and organ dysfunction, shock, and third space loss. Logistic regression analysis identified thrombocytopenia, organ dysfunction, and platelet transfusion requirement as significant predictors of the overall outcome. Etiological group comparisons revealed higher platelet transfusion requirements in the bacterial group. Conclusion: Prompt recognition and management of thrombocytopenia in acute undifferentiated fever are vital. Thrombocytopenia, along with organ dysfunction and shock, significantly influence patient outcomes. Tailored interventions based on etiological factors are crucial. Further research should focus on specific viral aetiologies in acute undifferentiated fever with thrombocytopenia.

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“…Thrombocytopenia has also been identified as a clinical manifestation of COVID-19 in half of the patients, and in almost 95% of cases the condition was found to be serious [32]. However, bleeding is rare even in the presence of DIC with thrombocytopenia.…”

Section: Endothelial Dysfunctionmentioning

confidence: 99%

Coagulopathy in severe COVID-19 patients: causes, concerns and current treatment regimen

Sengupta,

Luiz,

Suganthi

et al. 2024

Acta Haematol Pol.

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Elevated D-dimer and fibrinogen level, mild thrombocytopenia, modest prolongation of prothrombin time, and activated partial thromboplastin time, are key indicators of coagulopathy, and have been consistently reported in severely ill COVID-19 patients. Coronavirus disease 2019 (COVID-19)-induced coagulopathy can develop serious venous and arterial thromboembolic complications. Endothelial dysfunction and hypercoagulability, triggered mostly by overproduction of inflammatory cytokines as an immune response to the infection, are the pivotal factors responsible for the above-mentioned coagulation disorder. Thus, low-molecular-weight heparin (LMWH), which has both anticoagulant and anti-inflammatory properties, has been reported to improve disease prognosis. However, there have been increasing reports of venous thromboembolic events for intensive care unit patients suffering from COVID-19 despite the use of prophylactic doses of LMWH. Alternative clinical approaches involve the use of other antithrombotic agents, antiplatelet therapy, tissue plasminogen activator, and non-pharmacological tools. Ample cohort studies and clinical trials are needed to justify all these approaches of treatment. Finally, the discovery of several COVID-19 vaccines has reduced fatality from the disease enormously. However, prudent clinical practice still requires a circumspect response in order to deal with any potentially deleterious effects of coagulopathy.

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Severe Thrombocytopenia as a Manifestation of COVID-19 Infection

Cited by 7 publications

References 31 publications

Linezolid-Associated Thrombocytopenia: Assessment of Risk Factors in Patients without Hemato-Oncologic Diseases

Linezolid-Associated Thrombocytopenia: Assessment of Risk Factors in Patients without Hemato-Oncologic Diseases

Clinical and Etiological Profile of Acute Undifferentiated Fever With Thrombocytopenia in an Emergency Department

Coagulopathy in severe COVID-19 patients: causes, concerns and current treatment regimen

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