SHM Converge Scientific Abstract ePoster Gallery-A True Alphabet Soup: Refractory Thrombocytopenia in a Covid-19 Patient

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This case describes a 57-year-old man with CHF and CAD who presented with shortness of breath and severe hypoxia. He was found to be COVID-19 positive and had profound thrombocytopenia (platelets 7 K/uL), very elevated LDH and ferritin, and schistocytes on peripheral smear. Because his PLASMIC score suggested possible TTP, plasma exchange was started, but his platelet count did not improve. ADAMTS13 was not consistent with TTP, so PLEX was stopped. IVIG was then given for presumed ITP, but again there was no response.<br /><br />Additional testing showed elevated soluble IL-2 receptor, high triglycerides, and low natural killer cell levels. His H-score was 165, supporting a diagnosis of hemophagocytic lymphohistiocytosis (HLH), likely secondary to COVID-19. The patient’s clinical picture reflected the hyperinflammatory state that COVID-19 can cause and that may mimic HLH.<br /><br />The key takeaway is that refractory thrombocytopenia in a COVID-19 patient should prompt consideration of HLH or an HLH-like syndrome, especially when standard treatments for TTP or ITP fail. The case also highlights that COVID-19 can present with uncommon and severe hematologic complications that are still being defined. Treatment for HLH typically includes steroids and etoposide, but in this patient it was deferred because of severe multiorgan failure.

Asset Subtitle

Nida Khan

Meta Tag

Author List Nida Khan

Category Clinical Vignettes

Concept Thrombocytopenia

Concept Hemophagocytic Lymphohistiocytosis

Concept COVID-19

Concept Thrombotic Thrombocytopenic Purpura

Concept Immune Thrombocytopenia

Distinguished Non-Finalist

Presenter Organization Northwell Health

Presenting Author Nida Khan

Track Adult

Keywords

COVID-19

hemophagocytic lymphohistiocytosis

HLH

thrombocytopenia

TTP

ITP

plasma exchange

ADAMTS13

hyperinflammatory syndrome

schistocytes

Thrombocytopenia

Hemophagocytic Lymphohistiocytosis

COVID-19

Thrombotic Thrombocytopenic Purpura

Immune Thrombocytopenia