Fatih YAMAN, Neslihan ANDIC, Nur OGUZ DAVUTOGLU, Hava ÜSKÜDAR TEKE, Eren GUNDUZ

Covid-19 Enfeksiyonu Sonrası İmmün Trombositopeni Tanısı Alan Hastaların Retrospektif Analizi ve Literatür Özeti

İmmün trombositopenik purpura (ITP) olarak bilinen immün trombositopeni, COVID-19'un önemli bir komplikasyonu olarak ortaya çıkabilmektedir. COVID-19 ile ilişkili ITP'yi teşhis etmek için kapsamlı bir yaklaşım gereklidir. Bu çalışmada COVID-19 PCR pozitifliği sonrası ilk 60 gün içinde ITP tanısı alan 7 hasta sunulmuştur. Hastaların tanıdaki medyan trombosit sayısı 16x109/L’dir. Şiddetli hayatı tehdit eden kanama yoktu. COVID-19 semptomlarının başlangıcından ITP tanısına kadar geçen medyan gün sayısı 21 gün olarak bulundu. Kemik iliği baskılanması, mikrovasküler trombüs nedeniyle trombosit tüketimi veya trombositlerin otoimmün yıkımı gibi çeşitli mekanizmalar COVID-19 ilişkili trombositopeni nedeni olabilir. IVIG tedavisine yanıt alınmıştır ancak IVIG sonrası medyan 13 günde relaps gelişmiştir. Relaps olan hastalarda kortikosteroid kullanılabilir. COVID-19 sonrası hastalarda trombositopeni gelişimi açsından dikkatli olunmalıdır. Yeni tanı ITP’li hastalarda COVID-19 testi yapılmalıdır.

Anahtar Kelimeler:

COVİD-19, immun trombositopeni, tedavi

Retrospective Analysis of Patients Diagnosed with Immune Thrombocytopenia After Covid-19 Infection and Review of the Literature

Immune thrombocytopenia, known as immune thrombocytopenic purpura (ITP), has emerged as a major complication of COVID-19. A comprehensive approach is required to diagnose ITP associated with COVID-19. In this study, 7 patients who were diagnosed with ITP in the first 60 days after COVID-19 PCR positivity were presented. The median platelet count of the patients at diagnosis is 16x109/L. There was no severe life-threatening bleeding. The median day from the onset of COVID-19 symptoms to the diagnosis of ITP was 21 days. Various mechanisms such as bone marrow suppression, platelet consumption due to microvascular thrombus, or autoimmune destruction of platelets may be the cause of COVID-19-associated thrombocytopenia. Response to IVIG treatment was achieved, but relapse developed in a median of 13 days after IVIG. Corticosteroids can be used in patients with relapse. Care should be taken in terms of the development of thrombocytopenia in patients after COVID-19. Patients with newly diagnosed ITP should be tested for COVID-19.

Keywords:

COVİD-19, immune thrombocytopenia, treatment,

PDF

___

1 Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395: 497- 506.
2 Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020; 395: 507- 13.
3 Guan W-J, Ni Z-Y, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020; 382: 1708– 20.
4 Fan BE, Chong VCL, Chan SSW, et al. Hematologic parameters in patients with COVID‐19 infection. AJH. 2020; 95:131.
5 Xu P, Zhou Q, Xu J. Mechanism of thrombocytopenia in COVID‐19 patients. Ann Hematol. 2020; 99:1‐4
6 Audia S, Mahévas M, Samson M,et al. Pathogenesis of immune thrombocytopenia. Autoimmun Rev 2017;16:620–32
7 Zhang W, Nardi MA, Borkowsky W, et al. Role of molecular mimicry of hepatitis C virus protein with platelet GPIIIa in hepatitis C–related immunologic thrombocytopenia. Blood 2009;113:4086–93
8 Zhang y , Zeng X, Jiao Y, et al. Mechanisms involved in the development of thrombocytopenia in patients with COVID-19. Thrombozis research 2020;193:110-5
9 Neunert C, Lim W, Crowther M, et al. The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood 2011;117:4190–207
10 Zulfiqar A-A, Lorenzo-Villalba N, Hassler P, et al. Immune thrombocytopenic purpura in a patient with COVID-19. N Engl J Med 2020; 382:18
11 S. Humbert, J. Razanamahery, C. Payet-Revest et al. COVID-19 as a cause of immune thrombocytopenia. Méd Mal İnfect.2020;50:459–60
12 Yang X, Yang Q, Wang Y, et al. Thrombocytopenia and its association with mortality in patients with COVID‐19. J Thromb Haemost. 2020; 18:1469‐72.
13 Zhao J, Yuan Q, Wang H, et al. Antibody responses to SARS-CoV-2 in patients of novel coronavirus disease 2019. Clin Infect Dis 2020; 71:2027-34
14 Murt A, Eskazan AE, Yılmaz U, et al. COVID‐19 presenting with immune thrombocytopenia: a case report and review of the literatüre. J Med Virol. 2020; 10.1002/jmv.26138
15 Chen W, Yang B, Li Z, et al.. Sudden severe thrombocytopenia in a patient in the recovery stage of COVID‐19. Lancet Hematol. 2020;7:624
16 Bhattacharjee S, Banerjee M. Immune thrombocytopenia secondary to COVID-19: a systematic review. SN Comprehensive Clinical Medicine. 2020; 2:2048–58