COVID 19 infection associated with thrombotic thrombocytopenic purpura

J Thromb Thrombolysis. 2021 Aug;52(2):504-507. doi: 10.1007/s11239-021-02452-0. Epub 2021 Apr 27.

Abstract

Thrombotic thrombocytopenic purpura (TTP) which can cause significant mortality is a thrombotic microangiopathy due to deficiency of VWF cleaving protease ADAMTS13 and as per medical literature there are examples that TTP can be caused by COVID 19 infection. A 35 years old female after admission with right sided weakness and slurring of speech was found to be COVID positive and diagnosed as a case of TTP. Patient had absent ADAMTS13 level on day 1. Treatment was started with therapeutic plasma exchange (TPE) later injection Vincristine and Rituximab was given after 4th TPE as it was suspected as refractory case. Finally patient received 16 TPE procedures with cryo poor plasma as exchange fluid and gradually her platelet count started to maintain normal and she was discharged. Specific management and such association of this type of cases need to be studied more judiciously.

Keywords: Covid 19; Therapeutic plasma exchange; Thrombosis; Thrombotic thrombocytopenic purpura; Vincristine in TTP.

Publication types

  • Case Reports

MeSH terms

  • ADAMTS13 Protein* / blood
  • ADAMTS13 Protein* / deficiency
  • Adult
  • Antineoplastic Agents / administration & dosage
  • COVID-19* / blood
  • COVID-19* / complications
  • COVID-19* / diagnosis
  • Female
  • Humans
  • Immunologic Factors / administration & dosage
  • Plasma Exchange / methods
  • Platelet Count / methods
  • Purpura, Thrombotic Thrombocytopenic* / blood
  • Purpura, Thrombotic Thrombocytopenic* / diagnosis
  • Purpura, Thrombotic Thrombocytopenic* / etiology
  • Purpura, Thrombotic Thrombocytopenic* / therapy
  • Rituximab / administration & dosage*
  • SARS-CoV-2 / isolation & purification
  • Treatment Outcome
  • Vincristine / administration & dosage*

Substances

  • Antineoplastic Agents
  • Immunologic Factors
  • Rituximab
  • Vincristine
  • ADAMTS13 Protein
  • ADAMTS13 protein, human