COVID-19 associated thrombotic thrombocytopenic purpura (TTP) ; A case series and mini-review
International Immunopharmacology. 2021;93:107397
INTRODUCTION Thrombotic microangiopathies are a group of disorders that are mainly related to endothelial dysfunction. This category of endothelial dysfunction results of several imbalances between platelets, endothelium and immune system, also cytokine production. AIM OF THIS STUDY To report cases with thrombotic thrombocytopenic purpura (TTP) and COVID-19 and review COVID-19 endothelial dysfunction literature. METHODS Primary laboratory data, peripheral blood smear, ADAMTS13 antigen activity level, and antibody ordered for each of these four patients. Treatments for COVID-19 administered for all patients. Traditional treatments for TTP also were administered. RESULTS There were numerous schistocytes (more than 5%) in peripheral blood smears for each patient. ADAMTS13 antigen activity level was below 10%, and ADAMTS13 antibody was elevated for each patient. COVID-19 PCR was positive for all patients, and CT-Scans were indicative of the involvement of COVID-19. CONCLUSION In this case series, we reported four COVID-19 patients who presented with signs and symptoms of anemia and thrombocytopenia, resulting in thrombotic thrombocytopenic purpura.
Familial thrombocytopenia flare-up following the first dose of mRNA-1273 COVID-19 vaccine
American journal of hematology. 2021
Vaccine-induced immune thrombotic thrombocytopenia (VITT): targeting pathomechanisms with Bruton tyrosine kinase inhibitors
Thrombosis and haemostasis. 2021
A series of cases with rare thromboembolic incidents including cerebral sinus vein thrombosis (some of them fatal) and concomitant thrombocytopenia occurring shortly after vaccination with the COVID-19 vaccine AZD1222 (Vaxzevria) has caused significant concern and led to its temporary suspension in many countries. Immediate laboratory efforts in four of these patients have identified a tentative pathomechanism underlying this syndrome termed vaccine-induced prothrombotic immune thrombocytopenia (VIPIT) or vaccine-induced thrombosis with thrombocytopenia (VITT), which encompasses the presence of platelet-activating antibodies to platelet-factor 4/heparin complexes, possibly emulated by polyanionic constituents of AZD1222, and thus resembles heparin-induced thrombocytopenia (HIT). Because these immune complexes bind and activate platelets via Fcγ-receptor IIA (FcγRIIA), high-dose intravenous immunoglobulin G has been suggested for treatment of VIPIT in addition to non-heparin anticoagulants. Here we propose inhibitors of Bruton tyrosine kinase (Btk) approved for B-cell malignancies (e.g. ibrutinib) as another therapeutic option in VIPIT, as they are expected to pleiotropically target multiple pathways downstream of FcγRIIA-mediated Btk activation, e.g. as demonstrated for the effective inhibition of platelet aggregation, dense granule secretion, P-selectin expression and platelet-neutrophil aggregate formation stimulated by FcγRIIA cross-linking. Moreover, CLEC-2- and GPIb-mediated platelet activation, the interactions and activation of monocytes and the release of neutrophil extracellular traps, as encountered in HIT, could be attenuated by Btk inhibitors. As a paradigm for emergency repurposing of approved drugs in COVID-19, off-label use of Btk inhibitors in a low dose range not affecting haemostatic functions could thus be considered as a sufficiently safe option to treat VIPIT.
Immune Thrombocytopenia Secondary to COVID-19 Infection
The Israel Medical Association Journal : Imaj. 2021;23(6):342-343
A Case of COVID-19-Related Thrombocytopenia and Leukopenia in an Adolescent with Mild Symptoms
Since the beginning of the COVID-19 pandemic, there have been numerous reports and reviews on the complications caused by the disease, analyzing the acute and chronic consequences. The main symptoms of SARS-CoV-2 are dry cough, fever, and fatigue. COVID-19 appears to affect all systems, including renal, cardiovascular, circulatory, and respiratory systems, causing chronic obstructive pulmonary disease. We report on a 14-year-old male adolescent, who presented with thrombocytopenia (platelet count 92 × 109 /L) and leukopenia (white blood count 4.2 × 103 /μL) that was observed two months ago. Ten days before the first blood test, a viral infection with nasal congestion and runny nose was reported, without other accompanying symptoms. Viral antibodies screening revealed positivity for all the three specific COVID-19 antibodies. Further haematological evaluation with bone marrow aspiration revealed non-specific dysplastic features of the red cell and megakaryocyte progenitors. Although haematological alterations due to COVID-19 infection are available from adult patients’ reports, the effect of COVID-19 infection in the pediatric population is underestimated and this is the first case with such haematological involvement. Noteworthy, in the current case, the impact of the COVID-19 infection was not related to the severity of the disease, as the symptoms were mild. In similar cases, bone marrow aspiration would not be performed as a part of routine work-up. Thus, it is important when evaluating pediatric patients with COVID-19 infection to search and report those alterations in order to better understand the impact and the spectrum of clinical manifestations of the specific viral infection in children and adolescents.
Immune thrombocytopenia following multisystem inflammatory syndrome in children (MIS-C) - a case series
Pediatric Hematology and Oncology. 2021;:1-8
Patients with coronavirus disease 2019 (COVID-19) from novel coronavirus (SARS-CoV-2) infection may present with immune thrombocytopenia (ITP). Multisystem inflammatory syndrome in children (MIS-C) is a serious complication of SARS-CoV-2 causing systemic organ dysfunction. This case series presents the first reported cases of patients who developed ITP following MIS-C, while completing corticosteroid tapers. These patients responded to standard of care therapies for ITP and had appropriate platelet count recovery. We emphasize the importance of careful monitoring of those recovering from COVID-19 or MIS-C, to proactively identify clinical and laboratory abnormalities, in addition to long-term cardiovascular sequelae.
Thrombocytopenia following Pfizer and Moderna SARS/CoV-2 vaccination
American Journal of Hematology. 2021
Atypical manifestations of coronavirus disease 2019 (COVID-19)-associated autoimmune thrombotic thrombocytopenic purpura
Clinical Case Reports. 2021;9(3):1402-1404
Patients with coronavirus disease 2019 (COVID-19) infection can have various abnormal hematologic parameters. This report illustrates a case with unusual presentation of COVID-19-associated thrombotic thrombocytopenic purpura, in which the patient did not develop any typical respiratory signs or symptoms.
Immune thrombocytopenia during the COVID-19 pandemic
British journal of haematology. 2021
Vertical transmission, maternal thrombocytopenia & postpartum haemorrhage in coronavirus infection - a case report
BJOG: An International Journal of Obstetrics and Gynaecology. 2021;128(SUPPL 2):198-198
Objective New evidence is emerging regarding the effects of Coronavirus (COVID-19) in pregnancy. We report this case to highlight COVID-19 complications and challenges in the 3rd trimester of pregnancy. Case report A 35 years old, Para 1, had an uneventful pregnancy up to 36 weeks' gestation, when she was admitted with reduced fetal movements, feeling unwell, fever, and cough with a positive COVID-19 PCR. She was febrile, tachycardiac, and normotensive with no proteinuria. Symptomatic treatment was commenced with infection control measures. Cardiotocograph (CTG) was reassuring initially. Her platelet count was 66 9 109/L and her liver function tests (LFT) were mildly deranged. Peripheral blood film showed no signs of Microangiopathic hemolytic anemia. The hematologist suggested that thrombocytopenia was most likely related to COVID-19 & her isolated mildly prolonged APTT was corrected by Vitamin K. She was induced in view of intermittent decelerations on CTG and progressive thrombocytopenia. However, CTG became abnormal and she had a lower segment cesarean section under General Anastasia (because of thrombocytopenia). She delivered a 2.8 kg baby boy (APGAR score of 6 and 9 at 5 and 10 mins respectively, normal cord pH). Delivery was complicated by a Postpartum hemorrhage of 2 L, for which she was transfused one unit of platelets, and two units of red cells, along with oxytocics and antibiotics. Neonate was COVID-19 positive and had hyperbilirubinemia, which settled subsequently. The subsequent recovery of the mother was uneventful, with improvement in her platelet count and LFT. She was discharged home with her baby on the 4th postoperative day after the debriefing. She was prescribed thromboprophylaxis for 6 weeks and followed up as an outpatient. Discussion The management of COVID-19 in pregnancy should include a multidisciplinary approach, foeto-maternal surveillance, infection control measures, delivery planning, and psychological support. Rasmussen SA advocates the use of empiric antibiotics for secondary bacterial infection risk & mechanical support in case of respiratory compromise. Thrombocytopenia is a known complication of COVID-19 in pregnancy. Thromboprophylaxis is challenging in such patients and depends on risks and benefits, clotting profile, and the timing of delivery. Moreover, the differential diagnosis for epigastric pain in pregnancy with COVID-19 infection varies from gastritis and preeclampsia to hepatic and myocardial injury. Vertical transmission is a known risk of maternal COVID-19 infection. Conclusion As obstetric teams face COVID-19 pandemic associated foeto-maternal challenges, there is a need for holistic interventions for caveats arising from COVID-19 complications.