Mohammad Ameen M, Sgery Azri S H, Hussein Nawfal R
Department of Medicine, College of Medicine, University of Duhok, Kurdistan Region, Iraq.
Medical Student at College of Medicine, University of Duhok, Kurdistan Region, Iraq.
Ann Med Surg (Lond). 2021 Dec;72:103097. doi: 10.1016/j.amsu.2021.103097. Epub 2021 Nov 22.
Thrombocytopaenia, one of the most common haematological disorders worldwide, is characterised by platelet counts <150,000/mm. Patients with coronavirus disease (COVID-19) were found to commonly exhibit haematological abnormalities, often with mild forms of thrombocytopaenia. Absolute thrombocytopaenia tends to be rare among these patients and is believed to be secondary to immune-induced thrombocytopaenia.
A 53-y-old man presented with fever and generalised body ache that persisted for a few days. His polymerase chain reaction test was positive for COVID-19, for which he was treated with acetaminophen, levofloxacin, and favipiravir. On the third day of treatment, he noticed bruising and bleeding, mainly in the oral cavity, with clot formation. A complete blood picture (CBP) revealed severe thrombocytopaenia with an almost-zero count. Prednisone 1 mg/kg/d and frequent doses of intravenous platelet transfusion were administered as rescue therapy to prevent fatal bleeding. The patient was able to recover.
Immune thrombocytopaenia should be considered in patients presenting with bleeding tendencies after severe acute respiratory syndrome coronavirus 2 infection. Serial CBP is recommended for vulnerable patients, especially during the second and third weeks of hospitalisation, for the early detection and prevention of life-threatening COVID-19 complications.
Absolute thrombocytopaenia is a rare condition. Such a condition should be considered in patients presenting with bleeding tendencies with severe Covid-19 infection. With early diagnosis and appropriate treatment, patients' lives can be saved.
血小板减少症是全球最常见的血液系统疾病之一，其特征为血小板计数<150,000/mm³。冠状病毒病（COVID-19）患者通常表现出血液学异常，常伴有轻度血小板减少症。绝对血小板减少症在这些患者中往往较为罕见，被认为是免疫性血小板减少症的继发表现。
一名53岁男性出现发热和全身疼痛，持续数天。他的聚合酶链反应检测结果显示COVID-19呈阳性，为此他接受了对乙酰氨基酚、左氧氟沙星和法匹拉韦治疗。在治疗的第三天，他注意到有瘀伤和出血，主要在口腔，伴有血块形成。全血细胞计数（CBP）显示严重血小板减少症，计数几乎为零。给予泼尼松1mg/kg/d并频繁进行静脉血小板输注作为抢救治疗，以防止致命性出血。患者得以康复。
对于严重急性呼吸综合征冠状病毒2感染后出现出血倾向的患者，应考虑免疫性血小板减少症。建议对易感患者进行连续的CBP检查，尤其是在住院的第二周和第三周，以便早期发现和预防危及生命的COVID-19并发症。
绝对血小板减少症是一种罕见情况。对于患有严重COVID-19感染且有出血倾向的患者应考虑这种情况。通过早期诊断和适当治疗，可以挽救患者生命。
