COVID-19-associated thrombocytopenia: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
(Created page with "__NOTOC__ {{SI}} {{CMG}}; {{AE}} {{SK}} ==Overview== ==Historical Perspective== [Disease name] was first discovered by [name of scientist], a [nationality + occupation],...")
 
No edit summary
 
(66 intermediate revisions by 5 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Main|COVID-19}}
'''For COVID-19 frequently asked inpatient questions, click [[COVID-19 frequently asked inpatient questions|here]]'''<br>
'''For COVID-19 frequently asked outpatient questions, click [[COVID-19 frequently asked outpatient questions|here]]'''<br>
{{SI}}
{{SI}}


{{CMG}}; {{AE}}
{{CMG}}; {{AE}}{{SHA}}


{{SK}}  
{{SK}} Decrease in platelet count in COVID 19, effects of thrombocytopenia in COVID 19, thrombocytopenia complications of COVID 19


==Overview==
==Overview==
[[COVID-19|Coronavirus disease 2019 (COVID-19)]] is caused by a novel [[coronavirus]] called [[SARS-CoV-2]], which caused a respiratory illness [[outbreak]] that was first detected in Wuhan, China. [[Thrombocytopenia]] in [[COVID-19]] infection is more common in patients with severe infection and it has been reported that [[thrombocytopenia]] upon admission for [[COVID-19]] infection is associated with poor outcome and [[mortality]]. [[Thrombocytopenia]] is defined by platelet count <150 x <math>10^9</math>/L on [[Complete blood count|complete blood count (CBC)]]. The [[pathogenesis]] of [[thrombocytopenia]] in [[COVID-19]] infection is due to several factors such as: infection of [[bone marrow]], [[COVID-19-associated cytokine storm|cytokine storm]] caused by the [[COVID-19]] infection, increase in [[Autoantibody|autoantibodies]] and [[Immune complex|immune complexes]], [[lung]] injury which causes [[megakaryocyte]] fragmentation, and decrease in [[platelets]] which may be due to the activation of [[Platelet|platelets]] that result in [[platelet]] [[aggregation]].


==Historical Perspective==
==Historical Perspective==
[Disease name] was first discovered by [name of scientist], a [nationality + occupation], in [year]/during/following [event].
* [[COVID-19|Coronavirus disease 2019 (COVID-19)]] is caused by a novel [[coronavirus]] called [[SARS-CoV-2]], which caused a respiratory illness [[outbreak]] that was first detected in Wuhan, China.<ref>{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/about/index.html|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref><ref name="LuCui2020">{{cite journal|last1=Lu|first1=Jian|last2=Cui|first2=Jie|last3=Qian|first3=Zhaohui|last4=Wang|first4=Yirong|last5=Zhang|first5=Hong|last6=Duan|first6=Yuange|last7=Wu|first7=Xinkai|last8=Yao|first8=Xinmin|last9=Song|first9=Yuhe|last10=Li|first10=Xiang|last11=Wu|first11=Changcheng|last12=Tang|first12=Xiaolu|title=On the origin and continuing evolution of SARS-CoV-2|journal=National Science Review|year=2020|issn=2095-5138|doi=10.1093/nsr/nwaa036}}</ref>


The association between [important risk factor/cause] and [disease name] was made in/during [year/event].
* On January 30, 2020, the [[outbreak]] was declared a Public Health Emergency of International Concern.
 
* On March 12, 2020, the [[COVID-19]] outbreak was declared a [[pandemic]] by the [[World Health Organization|World Health Organization (WHO)]].
In [year], [scientist] was the first to discover the association between [risk factor] and the development of [disease name].
 
In [year], [gene] mutations were first implicated in the pathogenesis of [disease name].
 
There have been several outbreaks of [disease name], including -----.
 
In [year], [diagnostic test/therapy] was developed by [scientist] to treat/diagnose [disease name].


==Classification==
==Classification==
There is no established system for the classification of [disease name].
*[[Thrombocytopenia]] in general is defined by [[platelet]] count <150 x <math>10^9</math>/L on [[complete blood count]] ([[Complete blood count|CBC]]).<ref name="pmid28030481" />
 
*Classification of [[thrombocytopenia]] in general by [[platelet]] count is:<ref name="pmid22534274">{{cite journal| author=Gauer RL, Braun MM| title=Thrombocytopenia. | journal=Am Fam Physician | year= 2012 | volume= 85 | issue= 6 | pages= 612-22 | pmid=22534274 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22534274  }} </ref>
OR
**Mild: between 70,000 and 150,000 x <math>10^9</math>/L
 
**Severe: less than 20,000 x <math>10^9</math>/L
[Disease name] may be classified according to [classification method] into [number] subtypes/groups: [group1], [group2], [group3], and [group4].
*In general:<ref name="pmid22534274" />
 
**Most [[Thrombocytopenia|thrombocytopenic]] patients are [[asymptomatic]] if the [[platelet]] count is 50,000 x <math>10^9</math>/L or greater.
OR
**[[Thrombocytopenia|Thrombocytopenic]] patients with [[platelet]] count between 30 and 50 x <math>10^9</math>/L rarely have [[purpura]], but may have bleeding with [[Physical trauma|trauma]].
 
**[[Thrombocytopenia|Thrombocytopenic]] patients with [[platelet]] count between 10 and 30 x <math>10^3</math>/L may have bleeding with minor [[trauma]].
[Disease name] may be classified into [large number > 6] subtypes based on [classification method 1], [classification method 2], and [classification method 3].
**[[Thrombocytopenia|Thrombocytopenic]] patients with [[platelet]] count less than 10 x <math>10^3</math>/L have increased risk for spontaneous [[bleeding]], [[Petechia|petechiae]], and [[Bruise|bruising]].
[Disease name] may be classified into several subtypes based on [classification method 1], [classification method 2], and [classification method 3].
**In [[Thrombocytopenia|thrombocytopenic]] patients, spontaneous bleeding, which is an [[emergency]], usually occurs in patients with [[platelet]] counts less than 5 x <math>10^3</math>/L .
 
OR
 
Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.
 
OR
 
If the staging system involves specific and characteristic findings and features:
According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].
 
OR
 
The staging of [malignancy name] is based on the [staging system].
 
OR
 
There is no established system for the staging of [malignancy name].


==Pathophysiology==
==Pathophysiology==
The exact pathogenesis of [disease name] is not fully understood.
The [[pathogenesis]] of [[thrombocytopenia]] in [[COVID-19]] infection is due to several factors:<ref name="pmid32296910">{{cite journal| author=Xu P, Zhou Q, Xu J| title=Mechanism of thrombocytopenia in COVID-19 patients. | journal=Ann Hematol | year= 2020 | volume= 99 | issue= 6 | pages= 1205-1208 | pmid=32296910 | doi=10.1007/s00277-020-04019-0 | pmc=7156897 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32296910  }} </ref><ref name="pmid16019455">{{cite journal| author=Yang M, Ng MH, Li CK| title=Thrombocytopenia in patients with severe acute respiratory syndrome (review). | journal=Hematology | year= 2005 | volume= 10 | issue= 2 | pages= 101-5 | pmid=16019455 | doi=10.1080/10245330400026170 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16019455  }} </ref><ref name="pmid1350662">{{cite journal| author=Yeager CL, Ashmun RA, Williams RK, Cardellichio CB, Shapiro LH, Look AT | display-authors=etal| title=Human aminopeptidase N is a receptor for human coronavirus 229E. | journal=Nature | year= 1992 | volume= 357 | issue= 6377 | pages= 420-2 | pmid=1350662 | doi=10.1038/357420a0 | pmc=7095410 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1350662  }} </ref><ref name="pmid11551503">{{cite journal| author=Nardi M, Tomlinson S, Greco MA, Karpatkin S| title=Complement-independent, peroxide-induced antibody lysis of platelets in HIV-1-related immune thrombocytopenia. | journal=Cell | year= 2001 | volume= 106 | issue= 5 | pages= 551-61 | pmid=11551503 | doi=10.1016/s0092-8674(01)00477-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11551503  }} </ref><ref name="pmid28329764">{{cite journal| author=Lefrançais E, Ortiz-Muñoz G, Caudrillier A, Mallavia B, Liu F, Sayah DM | display-authors=etal| title=The lung is a site of platelet biogenesis and a reservoir for haematopoietic progenitors. | journal=Nature | year= 2017 | volume= 544 | issue= 7648 | pages= 105-109 | pmid=28329764 | doi=10.1038/nature21706 | pmc=5663284 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28329764  }} </ref><ref name="pmid32495027">{{cite journal| author=Liu X, Zhang R, He G| title=Hematological findings in coronavirus disease 2019: indications of progression of disease. | journal=Ann Hematol | year= 2020 | volume=  | issue=  | pages=  | pmid=32495027 | doi=10.1007/s00277-020-04103-5 | pmc=7266734 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32495027  }} </ref>
 
OR
 
It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].
 
OR
 
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.
 
OR
 
Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
 
OR
 
 
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].


OR
* Decrease in primary [[platelet]] production due to infection of [[bone marrow]] cells by [[Coronavirus|coronaviruses]] and inhibition of [[bone marrow]] growth, which lead to abnormal [[hematopoietic]] function.
*Decrease in [[Platelet|platelets]] may also be due to a [[COVID-19-associated cytokine storm|cytokine storm]] caused by the [[COVID-19]] infection which results in the destruction of [[bone marrow]] [[Progenitor cell|progenitor cells]].
* Increase in [[platelet]] destruction due to an increase in [[Autoantibody|autoantibodies]] and [[Immune complex|immune complexes]].
* Decrease in circulating [[platelet]] due to [[lung]] injury which causes [[megakaryocyte]] fragmentation and decreases platelet production, because the lung is a reservoir for [[megakaryocyte]] and [[hematopoietic]] [[Progenitor cell|progenitor cells]] and has a role in [[platelet]] production.
*In addition, a decrease in [[platelets]] may be due to the activation of [[Platelet|platelets]] that result in [[platelet]] [[aggregation]] and formation of micro-[[thrombus]] which increase [[platelet]] consumption.


The progression to [disease name] usually involves the [molecular pathway].
Summary of the mechanisms involved in [[thrombocytopenia]] in [[COVID-19]] infection:<ref name="pmid32296910" />[[ File:Covid 19 coagulation.jpg|center|800px]]
 
OR
 
The pathophysiology of [disease/malignancy] depends on the histological subtype.


==Causes==
==Causes==
Disease name] may be caused by [cause1], [cause2], or [cause3].
* [[COVID-19|Coronavirus disease 2019 (COVID-19)]] is caused by a novel [[coronavirus]] called [[SARS-CoV-2]]  and is the cause of [[thrombocytopenia]] in [[COVID-19]] infection.


OR
==Differentiating Thrombocytopenia from other Diseases==
* [[COVID-19|Coronavirus disease 2019 (COVID-19)]]  may cause [[thrombocytopenia]]. The differential diagnosis to consider for [[thrombocytopenia]] in general include:<ref name="pmid27866576">{{cite journal| author=Lee EJ, Lee AI| title=Thrombocytopenia. | journal=Prim Care | year= 2016 | volume= 43 | issue= 4 | pages= 543-557 | pmid=27866576 | doi=10.1016/j.pop.2016.07.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27866576  }} </ref>
**[[Pseudothrombocytopenia]]  
** Inherited [[Thrombocytopenia|thrombocytopenias]] ([[Bernard-Soulier syndrome]], [[Wiskott-Aldrich syndrome]], and [[thrombocytopenia]] with absent radii)  
**[[Immune thrombocytopenic purpura|Immune thrombocytopenic purpura (ITP)]] and drug-induced [[Idiopathic thrombocytopenic purpura|ITP]] (such as [[quinine]], [[Non-steroidal anti-inflammatory drug|NSAIDs]], [[glycoprotein IIb/IIIa inhibitors]])
**[[Heparin-induced thrombocytopenia|Heparin-induced thrombocytopenia (HIT)]]
**[[Thrombotic thrombocytopenic purpura|Thrombotic thrombocytopenic purpura (TTP)]]/[[Hemolytic uremic syndrome|hemolytic uremic syndrome (HUS)]]
** Drug-induced [[Thrombotic thrombocytopenic purpura|TTP]] (such as [[mitomycin]] C, [[gemcitabine]], [[oxaliplatin]])
**[[Disseminated intravascular coagulation|Disseminated intravascular coagulation (DIC)]]
**[[Hematologic]] disorders ([[lymphoma]], [[leukemia]], [[myelodysplastic syndrome]])
**[[Post-transfusion purpura]]
**[[Autoimmune]]-related [[thrombocytopenia]] (such as [[Systemic lupus erythematosus|systemic lupus erythematosus (SLE)]], [[Common variable immunodeficiency|common variable immunodeficiency (CVID)]], [[Antiphospholipid syndrome|antiphospholipid antibody syndrome]],[[thyroid]] disease)
**[[Tumor]] infiltration of bone marrow
**[[Bone marrow]] failure (such as [[aplastic anemia]], [[fanconi anemia]], and [[diamond-Blackfan anemia]])
**[[Liver]] disease
**[[Splenomegaly]]
**Infections ([[Epstein Barr virus|Epstein-Barr virus]], cytomegalovirus, [[hepatitis C]], [[Human Immunodeficiency Virus (HIV)|HIV]], [[parvovirus B19]], [[Helicobacter pylori|H pylori]])
** Drugs ([[Antibiotic|antibiotics]], [[alcohol]], [[chemotherapy]], [[radiation]])
**[[Folate deficiency]] or [[vitamin B12 deficiency]]
**Mechanical destruction (such as [[cardiopulmonary bypass]], [[intra-aortic balloon pump]])  


Common causes of [disease] include [cause1], [cause2], and [cause3].
For detailed differential diagnosis of [[thrombocytopenia]] click [[Thrombocytopenia differential diagnosis|here]]  
 
OR
 
The most common cause of [disease name] is [cause 1]. Less common causes of [disease name] include [cause 2], [cause 3], and [cause 4].
 
OR
 
The cause of [disease name] has not been identified. To review risk factors for the development of [disease name], click [[Pericarditis causes#Overview|here]].
 
==Differentiating ((Page name)) from other Diseases==
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
 
OR
 
[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].


==Epidemiology and Demographics==
==Epidemiology and Demographics==
The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide.
*[[Thrombocytopenia]] is seen in 36.2% of all patients with COVID-19 infection.<ref name="pmid32109013" />
 
*[[Thrombocytopenia]]<nowiki/> is seen in 57.7% of patients with severe [[COVID-19]] infection compared to 31.6 % of patients with non-severe infection.<ref name="pmid32109013">{{cite journal| author=Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX | display-authors=etal| title=Clinical Characteristics of Coronavirus Disease 2019 in China. | journal=N Engl J Med | year= 2020 | volume= 382 | issue= 18 | pages= 1708-1720 | pmid=32109013 | doi=10.1056/NEJMoa2002032 | pmc=7092819 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32109013  }} </ref>
OR
 
In [year], the incidence/prevalence of [disease name] was estimated to be [number range] cases per 100,000 individuals worldwide.
 
OR
 
In [year], the incidence of [disease name] is approximately [number range] per 100,000 individuals with a case-fatality rate of [number range]%.
 
 
 
Patients of all age groups may develop [disease name].
 
OR
 
The incidence of [disease name] increases with age; the median age at diagnosis is [#] years.
 
OR
 
[Disease name] commonly affects individuals younger than/older than [number of years] years of age.
 
OR
 
[Chronic disease name] is usually first diagnosed among [age group].
 
OR
 
[Acute disease name] commonly affects [age group].
 
 
 
There is no racial predilection to [disease name].
 
OR
 
[Disease name] usually affects individuals of the [race 1] race. [Race 2] individuals are less likely to develop [disease name].
 
 
 
[Disease name] affects men and women equally.
 
OR
 
[Gender 1] are more commonly affected by [disease name] than [gender 2]. The [gender 1] to [gender 2] ratio is approximately [number > 1] to 1.
 
 
 
The majority of [disease name] cases are reported in [geographical region].
 
OR
 
[Disease name] is a common/rare disease that tends to affect [patient population 1] and [patient population 2].


==Risk Factors==
==Risk Factors==
There are no established risk factors for [disease name].
* [[Thrombocytopenia]] in [[COVID-19]] infection is more common is patients with severe infection compared to patients with non-severe infection.<ref name="pmid32109013" />
 
OR
 
The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].
 
OR
 
Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
 
OR
 
Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.


==Screening==
==Screening==
There is insufficient evidence to recommend routine screening for [disease/malignancy].
* It has been reported that [[thrombocytopenia]] upon admission for [[COVID-19]] infection is associated with severe disease and [[mortality]].<ref name="pmid32557535">{{cite journal| author=Maquet J, Lafaurie M, Sommet A, Moulis G, Covid-Clinic-Toul investigators group. Alvarez M | display-authors=etal| title=Thrombocytopenia is independently associated with poor outcome in patients hospitalized for COVID-19. | journal=Br J Haematol | year= 2020 | volume=  | issue=  | pages=  | pmid=32557535 | doi=10.1111/bjh.16950 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32557535  }} </ref>
 
* However, there is insufficient evidence to recommend routine [[Screening (medicine)|screening]] and monitoring of [[thrombocytopenia]] for predicting disease progression in patients with [[COVID-19]] infection and further studies are required.<ref name="pmid32535232">{{cite journal| author=Zhang Y, Zeng X, Jiao Y, Li Z, Liu Q, Ye J | display-authors=etal| title=Mechanisms involved in the development of thrombocytopenia in patients with COVID-19. | journal=Thromb Res | year= 2020 | volume= 193 | issue=  | pages= 110-115 | pmid=32535232 | doi=10.1016/j.thromres.2020.06.008 | pmc=7274097 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32535232  }} </ref>
OR
 
According to the [guideline name], screening for [disease name] is not recommended.
 
OR
 
According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].


==Natural History, Complications, and Prognosis==
==Natural History, Complications, and Prognosis==
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
OR


Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
=== Natural History ===
* [[Thrombocytopenia]] is associated with an increased risk for severe [[COVID-19]] infection (threefold).<ref name="pmid32178975">{{cite journal| author=Lippi G, Plebani M, Henry BM| title=Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis. | journal=Clin Chim Acta | year= 2020 | volume= 506 | issue=  | pages= 145-148 | pmid=32178975 | doi=10.1016/j.cca.2020.03.022 | pmc=7102663 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32178975  }} </ref>


OR
=== Complications ===
*Complications of [[thrombocytopenia]] in patients with severe [[COVID-19]] infection may include:<ref name="pmid32535232" />
**[[Disseminated intravascular coagulation|Disseminated intravascular coagulation (DIC)]]
**[[Multiple organ dysfunction syndromes]]
**Death


Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
=== Prognosis ===
*It has been reported that [[thrombocytopenia]] upon admission for [[COVID-19]] infection is independently and strongly associated with poor outcome and [[mortality]].<ref name="pmid32557535" />


==Diagnosis==
==Diagnosis==
===Diagnostic Study of Choice===
===Diagnostic Study of Choice===
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
*The [[diagnostic study of choice]] for [[thrombocytopenia]] is [[complete blood count]] ([[Complete blood count|CBC]]).


OR
*[[Thrombocytopenia]] in general is defined by [[platelet count]] <150 x <math>10^9</math>/L on [[Complete blood count|CBC]].<ref name="pmid28030481" />
 
*The median [[platelet]] count in [[COVID-19]] patients with [[thrombocytopenia]] is 137,500 and 172,000 x <math>10^9</math>/L in severe and non-severe infection, respectively.<ref name="pmid32109013" />
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
There are no established criteria for the diagnosis of [disease name].


===History and Symptoms===
===History and Symptoms===
The majority of patients with [disease name] are asymptomatic.
*The median [[platelet]] count in [[COVID-19]] patients with [[thrombocytopenia]] is 137,500 and 172,000 x <math>10^9</math>/L in severe and non-severe infection, respectively.<ref name="pmid32109013" />
 
* In general, in [[Thrombocytopenia|thrombocytopenic]] patients, most patients are asymptomatic if the platelet count is 50,000 x <math>10^9</math>/L or greater.<ref name="pmid22534274" />
OR


The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
* In general, in [[Thrombocytopenia|thrombocytopenic]] patients should be questioned about:<ref name="pmid28030481" /><ref name="pmid22534274" />
**[[Bruise|Bruising]] or [[Petechia|petechiae]]
**[[Bleeding]] ([[melena]], [[epistaxis]], [[menorrhagia]], [[hematuria]], prolonged bleeding after procedures, [[Gingiva|gingival]] bleeding and blood in [[sputum]])  
** Past medical history  
**[[Family history]]
**[[Medication|Medications]] history
**[[Vaccination|Immunization]] history
** Changes in vision
**[[Rash]]
**[[Fever]]
** Recent travel
**[[Blood transfusion|Transfusion]] history


===Physical Examination===
===Physical Examination===
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
* The median [[platelet]] count in [[COVID-19]] patients with [[thrombocytopenia]] is 137,500 and 172,000 x <math>10^9</math>/L in severe and non-severe infection, respectively.<ref name="pmid32109013" />
 
* In general, in [[Thrombocytopenia|thrombocytopenic]] patients, most patients are asymptomatic if the [[platelet]] count is 50,000 x <math>10^9</math>/L or greater.<ref name="pmid22534274" />
OR
* The [[physical examination]] in patients with [[thrombocytopenia]] in general should include checking for:<ref name="pmid28030481">{{cite journal| author=Greenberg EM| title=Thrombocytopenia: A Destruction of Platelets. | journal=J Infus Nurs | year= 2017 | volume= 40 | issue= 1 | pages= 41-50 | pmid=28030481 | doi=10.1097/NAN.0000000000000204 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28030481  }} </ref>
** Bleeding ([[epistaxis]], bloody [[sputum]], [[Gingiva|gingival]] [[bleeding]], [[menorrhagia]], heavy [[bleeding]] after invasive procedures or [[childbirth]])<ref name="pmid24729754">{{cite journal| author=Ghoshal K, Bhattacharyya M| title=Overview of platelet physiology: its hemostatic and nonhemostatic role in disease pathogenesis. | journal=ScientificWorldJournal | year= 2014 | volume= 2014 | issue=  | pages= 781857 | pmid=24729754 | doi=10.1155/2014/781857 | pmc=3960550 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24729754  }} </ref><ref name="pmid23233580">{{cite journal| author=Stasi R| title=How to approach thrombocytopenia. | journal=Hematology Am Soc Hematol Educ Program | year= 2012 | volume= 2012 | issue=  | pages= 191-7 | pmid=23233580 | doi=10.1182/asheducation-2012.1.191 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23233580  }} </ref>
** Unexplained bruising ([[Petechia|petechiae]], [[purpura]], [[Bruise|ecchymosis]])
**[[Hepatosplenomegaly]]
**[[Abdominal]] [[tenderness]]
**[[Urinary tract]] (check for [[hematuria]])<ref name="pmid16711312" />
**[[Stool]] for [[occult blood]] (evaluation of [[Gastrointestinal tract|gastrointestinal]] and [[rectal]] bleeding)  
**[[Retinal]] [[hemorrhage]] on [[Fundoscopy|fundoscopic]] exam (evaluation of [[central nervous system]] [[bleeding]])<ref name="pmid16711312">{{cite journal| author=Sekhon SS, Roy V| title=Thrombocytopenia in adults: A practical approach to evaluation and management. | journal=South Med J | year= 2006 | volume= 99 | issue= 5 | pages= 491-8; quiz 499-500, 533 | pmid=16711312 | doi=10.1097/01.smj.0000209275.75045.d4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16711312  }} </ref>
**[[Neurology|Neurologic]] examination (check for [[Intracranial hemorrhage|intracranial bleeding]])<ref name="pmid16711312" />
**[[Soft tissue]] or [[joint]] [[bleeding]] is not associated with [[thrombocytopenia]] and other [[Coagulopathy|coagulation disorders]] such as [[Disseminated intravascular coagulation|DIC]] should be checked.<ref name="pmid23233580" /><ref name="pmid16711312" />


Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
=== Laboratory Findings ===


OR
*[[Complete blood count]] ([[Complete blood count|CBC]])''':''' [[Thrombocytopenia]] in general is defined by platelet count <150 x <math>10^9</math>/L on CBC.<ref name="pmid28030481" />
**The median [[platelet]] count in [[COVID-19]] patients with [[thrombocytopenia]] is 137,500 and 172,000 x <math>10^9</math>/L in severe and non-severe infection, respectively.<ref name="pmid32109013" />


The presence of [finding(s)] on physical examination is diagnostic of [disease name].
*[[Blood film|Peripheral blood smear]]: [[Peripheral blood smear]] may be helpful if there is suspicion of other disorders that cause [[thrombocytopenia]]. However, there is insufficient evidence recommending routine [[peripheral blood smear]] in [[COVID-19]] patients.
 
*Other [[laboratory]] testings (such as [[Human Immunodeficiency Virus (HIV)|HIV]], [[Hepatitis C|HCV]] testing, [[antibody]] testing, liver [[enzymes]] and [[Liver function tests|liver function testing]]) are performed if there is suspicion of other disorders that cause [[thrombocytopenia]].
OR
 
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
 
===Laboratory Findings===
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].
 
OR
 
Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
 
OR
 
[Test] is usually normal among patients with [disease name].
 
OR
 
Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
 
OR
 
There are no diagnostic laboratory findings associated with [disease name].


===Electrocardiogram===
===Electrocardiogram===
There are no ECG findings associated with [disease name].
* There are no [[The electrocardiogram|ECG]] findings associated with [[COVID-19]]-associated-[[thrombocytopenia]].
 
OR
 
An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].


===X-ray===
===X-ray===
There are no x-ray findings associated with [disease name].
* There are no [[X-rays|x-ray]] findings associated with [[COVID-19]]-associated-[[thrombocytopenia]].
 
OR
 
An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===Echocardiography or Ultrasound===
===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound  findings associated with [disease name].
* There are no [[echocardiography]]/[[ultrasound]] findings associated with [[COVID-19]]-associated-[[thrombocytopenia]].
 
OR
 
Echocardiography/ultrasound  may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no echocardiography/ultrasound  findings associated with [disease name]. However, an echocardiography/ultrasound  may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===CT scan===
===CT scan===
There are no CT scan findings associated with [disease name].
* There are no [[Computed tomography|CT]] scan findings associated with [[COVID-19]]-associated-[[thrombocytopenia]].
 
OR
 
[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===MRI===
===MRI===
There are no MRI findings associated with [disease name].
* There are no [[Magnetic resonance imaging|MRI]] findings associated with [[COVID-19]]-associated-[[thrombocytopenia]].
 
OR
 
[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===Other Imaging Findings===
===Other Imaging Findings===
There are no other imaging findings associated with [disease name].
* There are no other imaging findings associated with [[COVID-19]]-associated-[[thrombocytopenia]].
 
OR
 
[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].


===Other Diagnostic Studies===
===Other Diagnostic Studies===
There are no other diagnostic studies associated with [disease name].


OR
* There are no other diagnostic studies associated with [[COVID-19]]-associated-[[thrombocytopenia]].
 
* However, [[bone marrow biopsy]] may be helpful if there is suspicion of other disorders that cause [[thrombocytopenia]], but there is insufficient evidence recommending routine [[bone marrow biopsy]] in [[COVID-19]] patients.
[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].


==Treatment==
==Treatment==
===Medical Therapy===
===Medical Therapy===
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
The treatment options for [[thrombocytopenia]] in [[COVID-19]] infection include:<ref name="pmid32523922">{{cite journal| author=Lorenzo-Villalba N, Zulfiqar AA, Auburtin M, Schuhmacher MH, Meyer A, Maouche Y | display-authors=etal| title=Thrombocytopenia in the Course of COVID-19 Infection. | journal=Eur J Case Rep Intern Med | year= 2020 | volume= 7 | issue= 6 | pages= 001702 | pmid=32523922 | doi=10.12890/2020_001702 | pmc=7279909 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32523922  }} </ref>
 
OR
 
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
 
OR
 
The majority of cases of [disease name] are self-limited and require only supportive care.


OR
*[[Rituximab]]
 
*[[Thrombopoietin]] receptor [[agonists]] ([[eltrombopag]], [[avatrombopag]], [[romiplostim]])
[Disease name] is a medical emergency and requires prompt treatment.
*High-dose [[dexamethasone]] as an alternative to [[prednisone]]  
 
*[[Intravenous]] [[immunoglobulins]] ([[IVIG]]) (1 g/kg on 1 or 2 consecutive days or 0.4 g/kg per day for 5 days)
OR
*[[Intravenous]] anti-D (50–75 mg/kg once) (consider potential triggering of [[Disseminated intravascular coagulation|DIC]] or [[hemolysis]])
 
*[[Platelet]] [[Growth factor|growth factors]] in patients with [[bleeding]], high risk for [[bleeding]], unresponsive to [[prednisone]] (carefully evaluate due to the potential thrombotic events in [[Coronavirus|corona-virus]] infection)
The mainstay of treatment for [disease name] is [therapy].
*[[Platelet]] [[transfusion]] in refractory [[visceral]] or [[cerebral]] [[meningeal]] [[hemorrhage]]
 
OR
 
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
 
OR
 
[Therapy] is recommended among all patients who develop [disease name].
 
OR
 
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
 
OR
 
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
 
OR
 
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
 
OR
 
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].


===Surgery===
===Surgery===
Surgical intervention is not recommended for the management of [disease name].
* The mainstay of treatment for severe [[thrombocytopenia]] in [[COVID-19]] infection is medical therapy.  
 
* Surgery has not been reported to be indicated in [[thrombocytopenia]] in [[COVID-19]] infection.
OR
 
Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]
 
OR
 
The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].
 
OR
 
The feasibility of surgery depends on the stage of [malignancy] at diagnosis.
 
OR
 
Surgery is the mainstay of treatment for [disease or malignancy].


===Primary Prevention===
===Primary Prevention===
There are no established measures for the primary prevention of [disease name].
* There are no established measures for the [[primary prevention]] of [[thrombocytopenia]] in [[COVID-19]] infection.
 
OR
 
There are no available vaccines against [disease name].
 
OR
 
Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
 
OR
 
[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].


===Secondary Prevention===
===Secondary Prevention===
There are no established measures for the secondary prevention of [disease name].
* There are no established measures for the [[secondary prevention]] of [[thrombocytopenia]] in [[COVID-19]] infection. However, it may include avoidance of [[antiviral]] [[Medication|medications]].
 
OR
 
Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].


==References==
==References==
{{reflist|2}}
{{reflist|2}}
 
[[Category:Up-To-Date]]
{{WikiDoc Help Menu}}
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}
{{WikiDoc Sources}}

Latest revision as of 14:56, 5 August 2020

Main article: COVID-19

For COVID-19 frequently asked inpatient questions, click here
For COVID-19 frequently asked outpatient questions, click here

WikiDoc Resources for COVID-19-associated thrombocytopenia

Articles

Most recent articles on COVID-19-associated thrombocytopenia

Most cited articles on COVID-19-associated thrombocytopenia

Review articles on COVID-19-associated thrombocytopenia

Articles on COVID-19-associated thrombocytopenia in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on COVID-19-associated thrombocytopenia

Images of COVID-19-associated thrombocytopenia

Photos of COVID-19-associated thrombocytopenia

Podcasts & MP3s on COVID-19-associated thrombocytopenia

Videos on COVID-19-associated thrombocytopenia

Evidence Based Medicine

Cochrane Collaboration on COVID-19-associated thrombocytopenia

Bandolier on COVID-19-associated thrombocytopenia

TRIP on COVID-19-associated thrombocytopenia

Clinical Trials

Ongoing Trials on COVID-19-associated thrombocytopenia at Clinical Trials.gov

Trial results on COVID-19-associated thrombocytopenia

Clinical Trials on COVID-19-associated thrombocytopenia at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on COVID-19-associated thrombocytopenia

NICE Guidance on COVID-19-associated thrombocytopenia

NHS PRODIGY Guidance

FDA on COVID-19-associated thrombocytopenia

CDC on COVID-19-associated thrombocytopenia

Books

Books on COVID-19-associated thrombocytopenia

News

COVID-19-associated thrombocytopenia in the news

Be alerted to news on COVID-19-associated thrombocytopenia

News trends on COVID-19-associated thrombocytopenia

Commentary

Blogs on COVID-19-associated thrombocytopenia

Definitions

Definitions of COVID-19-associated thrombocytopenia

Patient Resources / Community

Patient resources on COVID-19-associated thrombocytopenia

Discussion groups on COVID-19-associated thrombocytopenia

Patient Handouts on COVID-19-associated thrombocytopenia

Directions to Hospitals Treating COVID-19-associated thrombocytopenia

Risk calculators and risk factors for COVID-19-associated thrombocytopenia

Healthcare Provider Resources

Symptoms of COVID-19-associated thrombocytopenia

Causes & Risk Factors for COVID-19-associated thrombocytopenia

Diagnostic studies for COVID-19-associated thrombocytopenia

Treatment of COVID-19-associated thrombocytopenia

Continuing Medical Education (CME)

CME Programs on COVID-19-associated thrombocytopenia

International

COVID-19-associated thrombocytopenia en Espanol

COVID-19-associated thrombocytopenia en Francais

Business

COVID-19-associated thrombocytopenia in the Marketplace

Patents on COVID-19-associated thrombocytopenia

Experimental / Informatics

List of terms related to COVID-19-associated thrombocytopenia

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shakiba Hassanzadeh, MD[2]

Synonyms and keywords: Decrease in platelet count in COVID 19, effects of thrombocytopenia in COVID 19, thrombocytopenia complications of COVID 19

Overview

Coronavirus disease 2019 (COVID-19) is caused by a novel coronavirus called SARS-CoV-2, which caused a respiratory illness outbreak that was first detected in Wuhan, China. Thrombocytopenia in COVID-19 infection is more common in patients with severe infection and it has been reported that thrombocytopenia upon admission for COVID-19 infection is associated with poor outcome and mortality. Thrombocytopenia is defined by platelet count <150 x <math>10^9</math>/L on complete blood count (CBC). The pathogenesis of thrombocytopenia in COVID-19 infection is due to several factors such as: infection of bone marrow, cytokine storm caused by the COVID-19 infection, increase in autoantibodies and immune complexes, lung injury which causes megakaryocyte fragmentation, and decrease in platelets which may be due to the activation of platelets that result in platelet aggregation.

Historical Perspective

Classification

Pathophysiology

The pathogenesis of thrombocytopenia in COVID-19 infection is due to several factors:[5][6][7][8][9][10]

Summary of the mechanisms involved in thrombocytopenia in COVID-19 infection:[5]

Causes

Differentiating Thrombocytopenia from other Diseases

For detailed differential diagnosis of thrombocytopenia click here

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications, and Prognosis

Natural History

Complications

Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

  • The median platelet count in COVID-19 patients with thrombocytopenia is 137,500 and 172,000 x <math>10^9</math>/L in severe and non-severe infection, respectively.[12]
  • In general, in thrombocytopenic patients, most patients are asymptomatic if the platelet count is 50,000 x <math>10^9</math>/L or greater.[4]

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography or Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

The treatment options for thrombocytopenia in COVID-19 infection include:[19]

Surgery

Primary Prevention

Secondary Prevention

References

  1. ↑ https://www.cdc.gov/coronavirus/2019-ncov/about/index.html. Missing or empty |title= (help)
  2. ↑ Lu, Jian; Cui, Jie; Qian, Zhaohui; Wang, Yirong; Zhang, Hong; Duan, Yuange; Wu, Xinkai; Yao, Xinmin; Song, Yuhe; Li, Xiang; Wu, Changcheng; Tang, Xiaolu (2020). "On the origin and continuing evolution of SARS-CoV-2". National Science Review. doi:10.1093/nsr/nwaa036. ISSN 2095-5138.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 Greenberg EM (2017). "Thrombocytopenia: A Destruction of Platelets". J Infus Nurs. 40 (1): 41–50. doi:10.1097/NAN.0000000000000204. PMID 28030481.
  4. ↑ 4.0 4.1 4.2 4.3 4.4 Gauer RL, Braun MM (2012). "Thrombocytopenia". Am Fam Physician. 85 (6): 612–22. PMID 22534274.
  5. ↑ 5.0 5.1 Xu P, Zhou Q, Xu J (2020). "Mechanism of thrombocytopenia in COVID-19 patients". Ann Hematol. 99 (6): 1205–1208. doi:10.1007/s00277-020-04019-0. PMC 7156897 Check |pmc= value (help). PMID 32296910 Check |pmid= value (help).
  6. ↑ Yang M, Ng MH, Li CK (2005). "Thrombocytopenia in patients with severe acute respiratory syndrome (review)". Hematology. 10 (2): 101–5. doi:10.1080/10245330400026170. PMID 16019455.
  7. ↑ Yeager CL, Ashmun RA, Williams RK, Cardellichio CB, Shapiro LH, Look AT; et al. (1992). "Human aminopeptidase N is a receptor for human coronavirus 229E". Nature. 357 (6377): 420–2. doi:10.1038/357420a0. PMC 7095410 Check |pmc= value (help). PMID 1350662.
  8. ↑ Nardi M, Tomlinson S, Greco MA, Karpatkin S (2001). "Complement-independent, peroxide-induced antibody lysis of platelets in HIV-1-related immune thrombocytopenia". Cell. 106 (5): 551–61. doi:10.1016/s0092-8674(01)00477-9. PMID 11551503.
  9. ↑ Lefrançais E, Ortiz-Muñoz G, Caudrillier A, Mallavia B, Liu F, Sayah DM; et al. (2017). "The lung is a site of platelet biogenesis and a reservoir for haematopoietic progenitors". Nature. 544 (7648): 105–109. doi:10.1038/nature21706. PMC 5663284. PMID 28329764.
  10. ↑ Liu X, Zhang R, He G (2020). "Hematological findings in coronavirus disease 2019: indications of progression of disease". Ann Hematol. doi:10.1007/s00277-020-04103-5. PMC 7266734 Check |pmc= value (help). PMID 32495027 Check |pmid= value (help).
  11. ↑ Lee EJ, Lee AI (2016). "Thrombocytopenia". Prim Care. 43 (4): 543–557. doi:10.1016/j.pop.2016.07.008. PMID 27866576.
  12. ↑ 12.0 12.1 12.2 12.3 12.4 12.5 12.6 Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX; et al. (2020). "Clinical Characteristics of Coronavirus Disease 2019 in China". N Engl J Med. 382 (18): 1708–1720. doi:10.1056/NEJMoa2002032. PMC 7092819 Check |pmc= value (help). PMID 32109013 Check |pmid= value (help).
  13. ↑ 13.0 13.1 Maquet J, Lafaurie M, Sommet A, Moulis G, Covid-Clinic-Toul investigators group. Alvarez M; et al. (2020). "Thrombocytopenia is independently associated with poor outcome in patients hospitalized for COVID-19". Br J Haematol. doi:10.1111/bjh.16950. PMID 32557535 Check |pmid= value (help).
  14. ↑ 14.0 14.1 Zhang Y, Zeng X, Jiao Y, Li Z, Liu Q, Ye J; et al. (2020). "Mechanisms involved in the development of thrombocytopenia in patients with COVID-19". Thromb Res. 193: 110–115. doi:10.1016/j.thromres.2020.06.008. PMC 7274097 Check |pmc= value (help). PMID 32535232 Check |pmid= value (help).
  15. ↑ Lippi G, Plebani M, Henry BM (2020). "Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis". Clin Chim Acta. 506: 145–148. doi:10.1016/j.cca.2020.03.022. PMC 7102663 Check |pmc= value (help). PMID 32178975 Check |pmid= value (help).
  16. ↑ Ghoshal K, Bhattacharyya M (2014). "Overview of platelet physiology: its hemostatic and nonhemostatic role in disease pathogenesis". ScientificWorldJournal. 2014: 781857. doi:10.1155/2014/781857. PMC 3960550. PMID 24729754.
  17. ↑ 17.0 17.1 Stasi R (2012). "How to approach thrombocytopenia". Hematology Am Soc Hematol Educ Program. 2012: 191–7. doi:10.1182/asheducation-2012.1.191. PMID 23233580.
  18. ↑ 18.0 18.1 18.2 18.3 Sekhon SS, Roy V (2006). "Thrombocytopenia in adults: A practical approach to evaluation and management". South Med J. 99 (5): 491–8, quiz 499-500, 533. doi:10.1097/01.smj.0000209275.75045.d4. PMID 16711312.
  19. ↑ Lorenzo-Villalba N, Zulfiqar AA, Auburtin M, Schuhmacher MH, Meyer A, Maouche Y; et al. (2020). "Thrombocytopenia in the Course of COVID-19 Infection". Eur J Case Rep Intern Med. 7 (6): 001702. doi:10.12890/2020_001702. PMC 7279909 Check |pmc= value (help). PMID 32523922 Check |pmid= value (help).

Template:WikiDoc Sources

Retrieved from "https://www.wikidoc.org/index.php?title=COVID-19-associated_thrombocytopenia&oldid=1647486"