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. 2020 Jul;190(2):179-184.
doi: 10.1111/bjh.16885. Epub 2020 Jun 18.

Delayed-phase thrombocytopenia in patients with coronavirus disease 2019 (COVID-19)

Wanxin Chen  1 , Ziping Li  1 , Bohan Yang  2 , Ping Wang  3 , Qiong Zhou  2 , Zhiguo Zhang  4 , Jianhua Zhu  5 , Xuexing Chen  1 , Peng Yang  6 , Hao Zhou  1
Affiliations

Delayed-phase thrombocytopenia in patients with coronavirus disease 2019 (COVID-19)

Wanxin Chen et al. Br J Haematol. 2020 Jul.

Abstract

Coronavirus disease 2019 (COVID-19) can affect the haematopoietic system. Thrombocytopenia at admission was prevalent, while late-phase or delayed-phase thrombocytopenia (occurred 14 days after symptom onset) is rare. This retrospective, single-centre study screened 450 COVID-19 patients and enrolled 271 patients at the Union Hospital, Wuhan, China, from January 25 to March 9, 2020. COVID-19-associated delayed-phase thrombocytopenia occurred in 11·8% of enrolling patients. The delayed-phase thrombocytopenia in COVID-19 is prone to develop in elderly patients or patients with low lymphocyte count on admission. The delayed-phase thrombocytopenia is significantly associated with increased length of hospital stay and higher mortality rate. Delayed-phase nadir platelet counts demonstrated a significantly negative correlation with B cell percentages. We also provided and described bone marrow aspiration pathology of three patients with delayed-phase thrombocytopenia, showing impaired maturation of megakaryocytes. We speculated that immune-mediated platelet destruction might account for the delayed-phase thrombocytopenia in a group of patients. In addition, clinicians need to pay attention to the delayed-phase thrombocytopenia especially at 3-4 weeks after symptom onset.

Keywords: COVID-19; SARS-CoV-2; clinical features; cytokine; lymphocyte; thrombocytopenia.

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Conflict of interest statement

All authors declare that they have no conflicts of interest.

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