COVID-19 Presenting With a Challenging Combination of Thrombocytopenia and Thrombosis

Swapna Ravi, Sushmita Khadka, Charumathi Subrahmanian Raghu, Ananth Ravi, Sharmisha Vanukuri, Tapasya Mandalapu, Vineela Kasireddy


Coronavirus disease 2019 (COVID-19) causes various hematological abnormalities, leading to several complications in the disease course. We report two COVID-19 cases presenting with a combination of thrombocytopenia and coagulopathy complications in late 2020. A 73-year-old male with a history of immune thrombocytopenic purpura (ITP) presented with acute ischemic stroke and acute thrombocytopenia in the setting of COVID-19. He was managed with steroids and intravenous immunoglobulin (IVIG) and had a subsequent acute ischemic stroke with microhemorrhages. Another 72-year-old female with a history of cryptogenic liver cirrhosis and chronic thrombocytopenia presenting with acute thrombocytopenia in the setting of COVID-19 was managed with steroids and IVIG. She had a coagulopathic complication of deep venous thrombosis (DVT) later in her disease course managed with inferior vena cava filter and low-dose enoxaparin, but she subsequently died with a bleeding complication of retroperitoneal hemorrhage. Despite the aggressive ongoing research, the treatment options for severe COVID-19 are limited to date and the mortality remains high. Both these cases are examples of challenging situations that the physicians are currently facing with COVID-19 pandemic.

J Med Cases. 2022;13(4):168-171


COVID-19; Thrombocytopenia; Coagulopathy; Thrombosis

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