IMMUNE THROMBOCYTOPENIC PURPURA IN AN ELDERLY PATIENT WITH COVID-19 (CLINICAL CASE)
Abstract
Immune thrombocytopenia (ITP) is an autoimmune disease characterized by a low platelet count and mucocutaneous bleeding. Many viruses have been identified as autoimmune triggers, including human immunodeficiency virus (HIV), hepatitis C virus (HCV), Epstein-Barr virus (EBV), cytomegalovirus (CMV), parvovirus, rubella, and measles. A rare association with the novel severe acute respiratory syndrome coronavirus, SARS-CoV-2 infection (Covid-19 infection),
has been reported. Here we report a case of ITP in an elderly patient caused by a novel coronavirus infection. He demonstrated an inadequate response to IVIG but responded to corticosteroids without serious side effects. Further research is needed to determine optimal therapeutic strategies for ITP in Covid-19 infection.
Keywords:
immune thrombocytopenic purpura, old age, COVID-19, treatment.References
1. Эсенгелди к.А., Садыкова А.А., Каратаева Г.Т., Мурзабек к.А., Маматова С.М., Эсенгелдиева О.Э. и др. Терапия идиопатической тромбоцитопенической пурпуры или иммунной тромбоцитопении. Вестник КРСУ. 2021;21 (5):143 148.
2. Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Provan D, Arnold D M, et al. Standardization of terminology,definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood. 2009;113:2386–93. https://doi.org/10.1182/blood-2008-07-162503
3. Liebman HA. Viral-associated immune thrombocytopenic purpura. Hematol Am Soc Hematol Educ Progr. 2008;212-8. https://doi.org/10.1182/asheducation-2008.1.212
4. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. China novel coronavirus I, research T: a novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382:727-33. https://doi.org/10.1056/NEJMoa2001017
5. Liu Y, Sun W, Guo Y, Chen L, Zhang L, Zhao S, et al. Association between platelet parameters and mortality in coronavirus disease 2019: retrospective cohort study. Platelets. 2020;31(4): 490–6. https://doi.org/10.1080/09537104. 2020.1754383
6. Zulfiqar AA, Lorenzo-Villalba N, Hassler P, Andrès E. Immune thrombocytopenic purpura in a patient with Covid-19. N Engl J Med. 2020;382(18):e43. https://doi.org/10.1056/NEJMc2010472
7. Bomhof G, Mutsaers PGNJ, Leebeek FWG, Te Boekhorst PAW, Hofland J, Croles FN, et al. COVID-19-associated immune thrombocytopenia. British J Haematol. 2020;190(2):e61-e64. https://doi.org/10.1111/bjh.16850
8. Sarfraz H, Anand K, Liu S, Shah S. Multiple myeloma with concurrent immunethrombocytopenic purpura. Ecancermed Sci. 2020;14:1012. https://doi.org/10.3332/ecancer.2020.1012
9. Terpos E, Ntanasis-Stathopoulos I, Elalamy I, Kastritis E, Sergentanis TN, Politou M, et al. Hematological findings and complications of COVID-19. Am J Hematol. 2020;95(7):834–847. https://doi.org/10.1002/ajh.25829
10. Assinger A. Platelets and infection – an emerging role of platelets in viral infection. Front Immunol. 2014;5:649. https://doi.org/10.3389/fimmu.2014.00649
11. Oldstone M.B. Molecular mimicry: its evolution from concept to mechanism as a cause of autoimmune diseases. Monoclon Antib Immunodiagn Immunother. 2014;33:158–165. https://doi.org/10.1089/mab.2013.0090
12. Donato AJ, Morgan RG, Walker AE, Lesniewski LA. Cellular and molecularbiology of aging endothelial cells. J Mol Cell Cardiol. 2015;89:122–135. https://doi.org/10.1016/j.yjmcc.2015.01.021
13. Cooper N, Ghanima W. Immune thrombocytopenia. N Engl J Med. 2019;381:945–55.https://doi.org/10.1056/NEJMcp 1810479
14. Jansen AJ, Swart RM, te Boekhorst P.A. Thrombopoietin-receptor agonists for immune thrombocytopenia. N Engl J Med. 2011;365(23): 2240–2241. https://doi.org/10.1056/NEJMc1112230
15. Connors JM, Levy JH. Thromboinflammation and the hypercoagulability of COVID-19. J Thromb Haemost. 2020;18 (7):1559–61. https://doi.org/10.1111/jth.14849
16. Olney HJ, Pabinger I, Mayer B, et al. Efficacy and safety of eltrombopag in elderly patients with chronic immune thrombocytopenia: analysis of five clinical trials. Blood. 2011;118:3294. https://doi.org/10.1182/blood.V118.21.3294.3294
