Continuous thrombocytopenia after SARS-CoV-2 nucleic acid negative in a non-severe COVID-19 patient for several months

Abstract

Background Thrombocytopenia was common in the coronavirus disease (Covid-19) patients during the infection, especially in severe COVID-19 patients, but was less in the non-severe Covid-19 patients. However, the platelet count would be restored after antivirus treatment. In this paper, we report continuous thrombocytopenia in a non-severe Covid-19 case after a negative nucleic acid test for Covid-19. Case presentation A non-severe COVID-19 patient had the platelet continuous decrease for several months after the SARS-CoV-2 nucleic acid turning negative, and without well response to the glucocorticoid. The dynamic change of platelet count followed that of the lymphocyte count. After excluding the medicines possibility, immune system disorders, other specific virus infection and specific antibody of platelet, the thrombocytopenia continuously lasted for several months. The upward trend did not begin until June 2020 and she took the tapering dose of prednisone under the instruction of the hematologist. Conclusion Excluding other potentialities inducing thrombocytopenia, we highly hypothesized the SARS-CoV-2 may cause thrombocytopenia by disturbing the immune system to induce the thrombocytopenia in our report,, which needs longer time to restore the immune system and platelet count via the glucocorticoid. We firstly reported this case in order to contribute the clinician to better deal with the patients like this.

Platelets in the perspective of COVID-19; pathophysiology of thrombocytopenia and its implication as prognostic and therapeutic opportunity

“…One of the therapeutic approaches that is considered for COVID-19 patients with thrombocytopenia and life-threatening hemorrhage is platelet transfusions, but serious caution should be measured as unnecessary transfusions may increase the risk of thrombotic events in patients with coagulopathy or ITP [10] . Wu et al indicated that platelet transfusion together with 10 mg dexamethasone could remarkably increase PLT count by 30 × 10 9 /L and ameliorate the bleeding in COVID-19 patients [146] . Lévesque et al also treated a COVID-19 patient with ITP and bleeding event with IVIG (1 g/Kg), dexamethasone (40 mg/day), and several PLT and RBC transfusions [147] .…”

Pulmonary embolism after dexamethasone treatment for COVID-19: a case report

“…Heparin administration restored the damaged endothelial cells, protected endothelial cells from leukocyte adhesion, and dismantled NETs, which prevented further cytokine release and thrombus formation [ 18 , 19 ]; and eventually the patient’s D-dimer, ferritin, and sIL-2R levels normalized. We hypothesize that heparin rather than steroid [ 20 ] administration, is essential to treat DVT and PE affected by dexamethasone administration.…”

Evaluation of the Hematological Patterns from Up to 985 Days of Long COVID: A Cross-Sectional Study

“…This observation heightens concerns over the potential long-term clinical consequences of COVID-19 [11,12] Among the various clinical and laboratory manifestations of the disease described throughout the COVID-19 pandemic, investigations of the hematological profile have proven important in the risk assessment of severe cases of COVID-19. Patients with an unfavorable disease evolution have hypercoagulable states and changes in platelet, leucocyte, and erythrocyte counts, indicating a poor prognosis; these parameters should be observed carefully [6,[13][14][15].…”

“…Some studies indicate that the hematological profile may remain altered during long COVID, with thrombotic events and leukocyte count imbalances observed [13][14][15]. Furthermore, while long COVID symptoms vary, abnormalities in hematological markers, particularly clotting parameters, related to COVID-19 infection are believed to play a role in the pathogenesis of long COVID symptoms [16].…”