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一名非重症 COVID-19 患者在 SARS-CoV-2 核酸阴性后连续数月出现血小板减少。

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

机构信息

Department of Hematology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.

Department of Internal Medicine, The Public and Health Clinic Centre of Chengdu, Chengdu, China.

出版信息

BMC Infect Dis. 2020 Oct 19;20(1):774. doi: 10.1186/s12879-020-05495-5.

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.

摘要

背景

在感染期间,冠状病毒病(Covid-19)患者中常出现血小板减少症,尤其是在重症 COVID-19 患者中,但在非重症新冠患者中较少见。然而,抗病毒治疗后血小板计数会恢复。本文报告了一例非重症新冠患者在新冠病毒核酸检测阴性后持续发生血小板减少症。

病例介绍

一位非重症 COVID-19 患者在 SARS-CoV-2 核酸转为阴性后,血小板持续减少数月,且对糖皮质激素反应不佳。血小板计数的动态变化与淋巴细胞计数的变化一致。在排除药物、免疫系统紊乱、其他特定病毒感染和血小板特异性抗体的可能性后,血小板减少症持续了数月。直到 2020 年 6 月,在血液科医生的指导下,她开始逐渐减少泼尼松的剂量,血小板计数才开始呈上升趋势。

结论

排除其他可能导致血小板减少症的因素后,我们高度怀疑 SARS-CoV-2 通过扰乱免疫系统引起血小板减少症,这需要更长的时间通过糖皮质激素来恢复免疫系统和血小板计数。我们首次报道了这例病例,以期为临床医生更好地处理此类患者提供参考。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c492/7574243/9084117832fb/12879_2020_5495_Fig1_HTML.jpg

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