Refractory thrombocytopenia in a severe COVID-19 patient

Submitted: 15 January 2021
Accepted: 22 April 2021
Published: 25 June 2021
Abstract Views: 406
PDF: 265
HTML: 5
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Severe acute respiratory syndromerelated coronavirus 2 (SARS-CoV-2) infection has spread worldwide. The most of patients presents fever, dyspnea and cough as a typical viral infection, others show peculiar clinical and laboratory signs, such as anosmia, ageusia and thrombocytopenia. We here describe a severe coronavirus disease 2019 patient (76-year old, male) that developed an immune thrombocytopenia and acquired pseudo-thrombocytopenia that were refractory to immunomodulators even after resolution of respiratory failure. The patient developed thrombocytopenia (platelets 88,000/mm3) that got worse the following day (14,000/mm3). We started 1 mg/kg of methylprednisolone i.v. daily. Platelet count increased up to 209,000/mm3, in sodium citrate, but remained about 14,000/mm3 in EDTA 10 days after the beginning of methylprednisolone. The patient showed great improvement in respiratory parameters and radiological finding. About one week after he developed a thrombocytopenia up to 70,000/mm3. We did not modify the steroids dosage. Platelet count slowly began to increase and in about 10 days returned to normal values.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020;382:727-33. DOI: https://doi.org/10.1056/NEJMoa2001017
Gattinoni L, Coppola S, Cressoni M, et al. COVID-19 does not lead to a "typical" acute respiratory distress syndrome. Am J Respir Crit Care Med 2020. [Epub ahead of print]. DOI: https://doi.org/10.1164/rccm.202003-0817LE
Gattinoni L, Chiumello D, Rossi S. COVID-19 pneumonia: ARDS or not? Crit Care 2020;24:154. DOI: https://doi.org/10.1186/s13054-020-02880-z
Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020. [Epub ahead of print]. DOI: https://doi.org/10.1001/jama.2020.1585
Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382:1708-20. DOI: https://doi.org/10.1056/NEJMoa2002032
Panyang Xu, Qi Zhou, Jiancheng Xu. Mechanism of thrombocytopenia in COVID-19 patients. Ann Hematol 2020;99:1205-08. DOI: https://doi.org/10.1007/s00277-020-04019-0
Fajgenbaum DC, June CH. Cytokine storm. N Engl J Med 2020;383:2255-73. DOI: https://doi.org/10.1056/NEJMra2026131
Zulfiqar A-A, Lorenzo-Villalba N, Hassler P, Andrès E. Immune thrombocytopenic purpura in a patient with COVID-19. N Engl J Med 2020;382:e43. DOI: https://doi.org/10.1056/NEJMc2010472
Phelan AL, Katz R, Gostin LO. The novel coronavirus originating in Wuhan, China: challenges for global health governance. JAMA 2020. [Epub ahead of print]. DOI: https://doi.org/10.1001/jama.2020.1097

How to Cite

Di Capua, M., Conca, A., Testa, S., Mascolo, M., & Paglia, S. (2021). Refractory thrombocytopenia in a severe COVID-19 patient. Geriatric Care, 7(2). https://doi.org/10.4081/gc.2021.9614