COVID-Induced Thrombotic Thrombocytopenic Purpura: A Case Report and Treatment-Focused Review

Abstract

Thrombotic thrombocytopenic purpura (TTP) is a rare disease that is part of a vast spectrum of thrombotic microangiopathies (TMAs). Despite the rarity of TTP, clinicians must maintain a high suspicion of this disease. The condition is characterized by fever, low platelets, hemolytic anemia, renal abnormalities, and neurological dysfunction. However, all these symptoms are not necessarily present in all the patients. In this review, we describe a case of a 51-year-old female who presented to the emergency department (ED) with chief complaints of dizziness and lightheadedness, subsequently leading to a diagnosis of TTP, caused as a result of COVID-19. This review raises awareness so that there is early recognition of any hematological manifestations associated with COVID-19, reducing the morbidity and mortality associated with the disease. Due to the unpredictability of COVID-19 and its complications, robust research is needed to understand the mechanism and determine which patients are more at risk for adverse outcomes.

Keywords: acquired ttp; caplacizumab; covid-19; refractory thrombocytopenia; rituximab therapy; thrombotic microangiopathy (tma); thrombotic thrombocytopenic thrombocytopenia.

Figure 1. Peripheral blood smear

Peripheral blood smear showed four to five schistocytes per high power field (HPF). The yellow arrow marks the schistocyte.

Figure 2. Peripheral blood smear

Peripheral blood smear showed four to five schistocytes per high power field (HPF). The yellow arrow marks the schistocyte.

Figure 3. Trend of patient's platelets during the hospital stay