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Immune Thrombocytopenia associated with severe COVID-19 Infection

Rasha Awawdeh, Fuad AlSaraj, Reem Allateef, Nassim Salamin, Martin Anson Lee, Mohammad AlThahyabt and Jorgen Kristensen

Serious hematological complications of COVID-19 are well recognized and are often related to dysfunction of coagulation. Several clinical and laboratory degrees of thrombocytopenia have been reported in association with COVID-19, varying from mild cases to severe cases with fatal outcomes. Extreme thrombocytopaenia may correlate with the severity of the infection and several mechanisms have been proposed to account for the low platelet count in this pandemic. We present a case of a 37-year-old male admitted via our emergency department with a ten-day history of classic symptoms of acute lower respiratory tract infection associated with anosmia and ageusia. He had a positive nasal swab PCR for COVID-19. His platelet count was initially normal, 168 × 103/μL (150-400 103/μL) but was followed by a gradual reduction throughout hospitalization to 10 × 103/μL. His thrombocytopaenia was initially managed with steroids and intravenous immunoglobulin therapy. Due to poor response to these treatments, Romiplostim was added and resulted in a slow increase in platelet count to 124 × 103/μL on the day of discharge. Platelet transfusion was not considered because the patient had no bleeding. The increase of platelet count and response to therapy coincided with clinical improvement from COVID-19.