Thrombocytopenia as an initial manifestation of COVID‐19; case series and literature review

Abstract

COVID-19 has been declared as a global pandemic, affecting more than a hundred countries in a matter of weeks and claiming many lives up until now. The clinical spectrum ranges from asymptomatic carriers to symptomatic patients with mild symptoms and patients requiring intensive care unit (ICU) admission at the other extreme. Variable clinical presentations have been reported, most commonly involving the chest with shortness of breath being most common. Less commonly it has also been reported with gastrointestinal and neurological manifestations. Haematological manifestations in symptomatic COVID-19 patients include severe leukopenia with lymphopenia and mild thrombocytopenia with platelet counts ranging between 100-150 9 10 9 /l. [1][2][3][4] We hereby report a case series of three patients; the first two patients presented with severe thrombocytopenia and were subsequently found to be COVID-19positive. The third case emphasises the presentation of severe thrombocytopenia as a marker of severity and poor prognosis in symptomatic COVID-19 patients.

Clinical Features of Critical Coronavirus Disease 2019 in Children*

“…U.S. hospitals have reported lower proportions of intubated critically ill pediatric COVID-19 patients and fewer ventilated days (8,9). Thrombocytopenia was associated with critical illness and has been described as an early finding in patients with COVID-19 (10). Thrombocytopenia is suspected to be multifactorial and could be due to cytokine storm or direct effects of SARS-CoV-2 on bone marrow, host immunity, or lung parenchyma (11).…”

Immune Thrombocytopenia Secondary to COVID-19: a Systematic Review

“…In the study population, 26 patients had complete response and 8 patients showed only response to treatment according to study definition. A total of 3 individuals expired: one was due to intracranial hemorrhage [11] and others succumbed to severity of COVID-19 illness after showing platelet response to treatment [15,27]. A total of 4 patients (9%) had relapse following treatment response in the followup period [13,14].…”

“…In two patients, the microhemorrhage in ventricles or subarachnoid space was not life-threatening. Non-ICH severe forms of bleeding, such as gastrointestinal bleed, metrorrhagia, and hematuria, were reported in 7 patients [11,14,15,18,25,29]. Severe forms of bleeding at ITP onset were found to be rare (< 1%) in a large population-based study comprising 3771 incident ITP patients [52].…”

Immune Thrombocytopenic Purpura – Different Presentations in Two COVID-19 Patients

“…The other previously reported cases had also heterogeneous presentations (different phases of COVID-19 and severity) and several treatments and results [2][3][4][5][6][7][8][9]. Twelve out of 14 were treated with Immunoglobulin, five additionally with corticosteroids and two received platelet transfusions.…”

“…It was previously reported to be associated with a different coronavirus strain [1]. Recently a number of cases of ITP have been reported associated with SARS-CoV-2 [2][3][4][5][6][7][8][9].…”