Department of General Medicine, D. M. Wayanad Institute of Medical Sciences, Wayanad, Kerala, India.
Indian J Pathol Microbiol. 2022 Jul-Sep;65(3):702-704. doi: 10.4103/ijpm.ijpm_774_21.
While disseminated intravascular coagulation (DIC) is a serious complication of COVID-19, a close differential in critically ill patients with thrombocytopenia is Thrombotic thrombocytopenic purpura (TTP).
We describe the case of a middle-aged lady admitted with COVID-19 pneumonia who developed progressive thrombocytopenia, altered sensorium and renal failure. The absence of coagulation abnormalities alerted to the possibility of TTP, strengthened by presence of schistocytes in peripheral smear.
This case highlights the need for high index of suspicion and to pay attention to normal tests as well that might give clues to the diagnosis. New onset thrombocytopenia in COVID-19 need not always indicate DIC. A careful examination of peripheral smear may help diagnosing TTP especially if coagulation profile is normal.
弥散性血管内凝血（DIC）是 COVID-19 的严重并发症，但对于血小板减少的危重症患者，需要密切鉴别血栓性血小板减少性紫癜（TTP）。
我们描述了一例中年女性因 COVID-19 肺炎入院，随后出现进行性血小板减少、意识改变和肾功能衰竭。外周血涂片存在裂片红细胞提示存在 TTP 的可能，且无凝血异常，这进一步支持了 TTP 的诊断。
本病例强调了需要高度怀疑，并注意可能提示诊断的正常检查。COVID-19 中新发的血小板减少不一定总是提示 DIC。仔细检查外周血涂片有助于诊断 TTP，尤其是在凝血谱正常的情况下。
