Hematological disorders as a manifestation of post-COVID syndrome: thrombocytopenia | Ukrainian Medical Journal

Aim: to investigate cases of thrombocytopenia caused by COVID-19, to analyze clinical characteristics, features of course of the disease and treatment.

Materials and methods. Analysis of clinical manifestation, anamnesis, laboratory and instrumental data of 25 patients with thrombocytopenia that occurred after the COVID-19.

Results. 15 patients were found to have thrombocytopenia after SARS-CoV-2 infection (11 women and 4 men aged 21 to 80 years). The onset of thrombocytopenia ranged from 1 day to 9 months after the onset of symptoms of COVID-19. The number of platelets at the first detection of their reduced level was 2–95·10⁹/l.

Conclusion. COVID-associated thrombocytopenia can be considered as a complication of COVID-19 and as one of the manifestations of the post-COVID syndrome. The most likely mechanism of its development is increased destruction of platelets caused by the formation of antiplatelet antibodies as a result of dysregulation of the immune response and molecular mimicry. In several patients thrombocytopenia was asymptomatic, but some of them had typical clinical manifestations. Treatment with glucocorticoids was effective in most patients, but sometimes required additional use of thrombopoietin receptor agonists and/or transfusions of platelet concentrate. Thrombocytopenia may become recurrent or chronic, and may also be accompanied by autoimmune hemolytic anemia.

References

1. Beyerstedt S., Casaro E.B., Rangel Е.B. (2021) COVID-19: angiotensin-converting enzyme 2 (ACE2) expression and tissue susceptibility to SARS-CoV-2 infection. Eur. J. Clin. Microbiol. Infect. Dis., 40: 905–919. DOI: 10.1007/s10096-020-04138-6.
2. Silva A.B., Siqueira S., de Assis Soares W.R. et al. (2021) Long-COVID and Post-COVID Health Complications: An Up-to-Date Review on Clinical Conditions and Their Possible Molecular Mechanisms. Viruses, 13(4): 700. DOI: 10.3390/v13040700.
3. Agbuduwe C., Basu S. (2020) Haematological manifestations of COVID-19: from cytopenia to coagulopathy. Eur. J. Haematol., 105(5): 540–546. DOI: 10.1111/ejh.13491.
4. Bhattacharjee S., Banerjee M. (2020) Immune thrombocytopenia secondary to COVID-19: a systematic review. SN Compr. Clin. Med., 2(18): 2048–2058. DOI: 10.1007/s42399-020-00521-8.
5. Hu B., Huang S., Yin L. (2021) The cytokine storm and COVID-19. J. Med. Virol., 93(1): 250–256. DOI: 10.1002/jmv.26232.
6. Li C., Li J., Ni H. (2020) Crosstalk between platelets and microbial pathogens. Front. Immunol., 11: 1962. DOI: 10.3389/fimmu.2020.01962.
7. Lippi G., Plebani M., Henry B.M. (2020) Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: a meta-analysis. Clin. Chim. Acta., 506: 145–148. DOI: 10.1016/j.cca.2020.03.022.