Mei Shuqin, Xue Cheng, Zhang Zheng, Liu Lingling, Cai Wenwen, Gong Xuelian, Mao Zhiguo, Tang Xiaojing, Dai Bing
Kidney Institute of PLA, Department of Nephrology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China.
Department of Hematology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China.
J Blood Med. 2024 Nov 29;15:495-500. doi: 10.2147/JBM.S496127. eCollection 2024.
Severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection has been a global threat since the end of 2019. Although the main clinical manifestation of coronavirus disease 2019 (COVID-19) is respiratory, its range of clinical manifestation is extensive and may include various systems, including hematological disorders, such as lymphopenia, thrombotic events, thrombocytopenia and immune thrombocytopenic purpura (ITP). The present case was the first one that aimed to raise awareness of ITP induced by COVID-19 in patients undergoing maintenance hemodialysis.
This is the case of a 75-year-old Asian woman who was diagnosed COVID-19 positive 15 days before attending our Emergency Department on January 19th, 2023, with a three-day history of severe bleeding symptoms, including gastrointestinal, mucosal bleeding, epistaxis, and the platelet count of 5×10/L. She suffered from end-stage kidney disease due to autosomal dominant polycystic kidney disease and has received thrice-weekly maintenance hemodialysis (MHD) since 2012. Platelet count recovery was observed after 45 days of combined treatment with corticosteroids, intravenous immunoglobulin, thrombopoietin receptor agonists, and rituximab. The count of platelets rose to 180×10/L after four dosages of Rituximab.
In brief, SARS-CoV-2 infection might trigger the onset of ITP. To our knowledge, this is the first case with severe and refractory ITP secondary to COVID-19 in MHD patients and no guidelines were able to be referred on the therapy. Nephrologists must be concerned with clinical characteristics, diagnostic flowcharts, and therapy for SARS-CoV-2-induced ITP.
自2019年底以来，严重急性呼吸综合征冠状病毒（SARS-CoV-2）感染一直是全球威胁。尽管2019冠状病毒病（COVID-19）的主要临床表现为呼吸道症状，但其临床表现范围广泛，可能累及多个系统，包括血液系统疾病，如淋巴细胞减少、血栓形成事件、血小板减少和免疫性血小板减少性紫癜（ITP）。本病例旨在提高对维持性血液透析患者中COVID-19诱发ITP的认识。
这是一名75岁的亚洲女性患者，于2023年1月19日就诊于我院急诊科，15天前被诊断为COVID-19阳性，有三天严重出血症状史，包括胃肠道出血、黏膜出血、鼻出血，血小板计数为5×10/L。她因常染色体显性多囊肾病患有终末期肾病，自2012年以来每周接受三次维持性血液透析（MHD）。在联合使用皮质类固醇、静脉注射免疫球蛋白、血小板生成素受体激动剂和利妥昔单抗治疗45天后，观察到血小板计数恢复。在使用四次利妥昔单抗后，血小板计数升至180×10/L。
简而言之，SARS-CoV-2感染可能引发ITP的发作。据我们所知，这是首例MHD患者继发于COVID-19的严重难治性ITP病例，且在治疗方面尚无指南可供参考。肾病学家必须关注SARS-CoV-2诱发ITP的临床特征、诊断流程和治疗方法。
