SHM Converge Scientific Abstract ePoster Gallery-Exploring the Synapse of Refractory TTP With Asymptomatic Covid-19 Infection

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A 62-year-old woman with diabetes, hyperlipidemia, and hypertension presented with a brief, 10-minute episode of transient left-sided weakness and dysarthria that fully resolved before ED arrival. Stroke evaluation, including CT head, CTA neck, and MRI brain, was negative. She was neurologically normal on exam, but labs showed evidence of microangiopathic hemolytic anemia and thrombocytopenia consistent with thrombotic thrombocytopenic purpura (TTP): elevated LDH, indirect hyperbilirubinemia, reticulocytosis, low haptoglobin, and schistocytes on peripheral smear. Coombs testing was negative, and nasopharyngeal SARS-CoV-2 screening was positive despite no respiratory or systemic COVID symptoms.<br /><br />With no other clear secondary cause identified, her acquired TTP was attributed to asymptomatic COVID-19 infection. Her course was refractory and required escalation of therapy: plasma exchange, high-dose steroids, rituximab, and caplacizumab. Platelets initially improved, then dropped again after plasma exchange was stopped, prompting resumption of treatment and later addition of rituximab and caplacizumab. She ultimately stabilized after 10 rounds of plasmapheresis and was discharged on steroids, weekly rituximab, and daily caplacizumab.<br /><br />This case highlights several important teaching points: neurologic symptoms may be the only presenting sign of COVID-19-associated TTP; asymptomatic SARS-CoV-2 infection can trigger severe TTP; and COVID-related TTP may be unusually refractory, requiring multiple treatment modalities including caplacizumab. Prompt recognition and aggressive management are essential because TTP is a life-threatening emergency.

Asset Subtitle

Vatsal Y. Bhatt

Meta Tag

Author List Vatsal Y. Bhatt

Category Clinical Vignettes

Concept Thrombotic Thrombocytopenic Purpura

Concept Total Plasma Exchange

Concept Schistocytes

Concept Thrombotic Microangiopathy

Concept Hemolytic Anemia

Distinguished Non-Finalist

Presenter Organization Brigham and Women's Hospital

Presenting Author Vatsal Y. Bhatt

Track Adult

Keywords

thrombotic thrombocytopenic purpura

COVID-19

asymptomatic SARS-CoV-2 infection

transient ischemic attack

microangiopathic hemolytic anemia

thrombocytopenia

plasma exchange

caplacizumab

rituximab

neurologic symptoms

Thrombotic Thrombocytopenic Purpura

Total Plasma Exchange

Schistocytes

Thrombotic Microangiopathy

Hemolytic Anemia