Critical Care COVID-19 Patient with a Picture of Thrombotic Thrombocytopenic Purpura

  • Rehab AL-Ansari Adult Hematology Unit, Internal Medicine Department, KFMMC, Dhahran, Kingdom of Saudi Arabia http://orcid.org/0000-0003-4331-5769
  • Mohanad Bakkar Internal Medicine Department, KFMMC, Dhahran, Kingdom of Saudi Arabia
  • Leena Abdalla Internal Medicine Department, KFMMC, Dhahran, Kingdom of Saudi Arabia
  • Khaled Sewify Critical Care Department, KFMMC, Dhahran, Kingdom of Saudi Arabia

Keywords

Thrombotic thrombocytopenic purpura, COVID-19, plasma exchange, cytokine storm

Abstract

Background: Thrombotic thrombocytopenic purpura (TTP) is an uncommon haematological disease which can occur at any age and may present with COVID-19. This case describes a COVID-19 complication associated with a presentation resembling TTP.

Case description: A 51-year-old man who had received a kidney transplant and was on immunosuppressant medication, was admitted to a critical care unit with severe COVID-19 pneumonia/acute respiratory distress syndrome (ARDS) which required intubation, mechanical ventilation and inotropic support. The course was complicated by the classic pentad of thrombocytopenia, intravascular haemolysis, acute kidney injury, neurological symptoms and fever, which prompted the diagnosis of probable TTP. After five sessions of therapeutic plasma exchange, the patient’s general status improved, he was weaned off mechanical ventilation and his renal panel and haemolytic markers normalized.

Conclusion: TTP is a life-threatening condition which requires urgent management with therapeutic plasma exchange. This case highlights some possible complications of COVID-19 generally and in immunocompromised patients specifically. The potential role of plasma exchange in COVID-19 patients without a positive diagnosis of TTP (the so-called ‘TTP resembling presentation’) is an area of further research.

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Published: 2020-12-15

Issue: Vol 8 No 1 (view)

Section: Articles

How to cite:
1.
AL-Ansari R, Bakkar M, Abdalla L, Sewify K. Critical Care COVID-19 Patient with a Picture of Thrombotic Thrombocytopenic Purpura . EJCRIM 2020;8 doi:10.12890/2020_002143.