A 27 y.o. male presented 8/21 with petechiae after being seen for pharyngitis which was strep/HIV/p24 Ag/covid negative.
His platelet count was 2,000 and he did not respond to platelet transfusion. He was discharged on tavalisse but returns with severe chest pain. What could be wrong?
the patient noted petechiae on multiple places on his body and complained his gums were bleeding when he brushed his teeth.
Our patient developed pulmonary emboli even though his platelet count was low. Splenectomized and elderly patients tend to be at risk for clotting even with low platelets.
Immune thrombocytopenia- is a group of heterogeneous disorders that cause platelet autoantibodies. A platelet count of < 100,000 is necessary to make the diagnosis. 80% respond to IVIG, splenectomy or rituximab. In refractory cases a thrombopoietin receptor agonist , eltrombopag or romiplostim can be given.
Thrombocytopenia is a recognized complication after Epstein-Barr virus infection, varicella, cmv, rubella, HIV, and hepatitis A, B or C. In children recovery usually occurs without treatment. In adults, however, the disease may become chronic. Recently, ITP has been reported after COVID infection.
ITP has been reported with lupus, hiv and many other conditions.
ITP is characterized by the duration of the thrombocytopenia. Acute ITP lasts fewer than 3 months, , persistent lasts 3-12 months, and chronic lasts longer than 12 months. Treatment is instituted when the platelet count in <30,000 or significant bleeding occurs. Our patient has had low platelets for three months and developed hemolytic anemia with haptoglobin < 10. He continues on Tavalisse. B cell malignancies are associated with ITP and autoimmune hemolytic anemia and he is being followed for the possible development of lymphoma
Patient presenting with ITP after a COVID infection
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