ABSTRACT
BACKGROUND: Coronavirus disease 2019 (COVID-19) still is a global emergency. According to the studies, pregnant women are of the at risk populations and any underlying disease(s) might even worsen their condition. The aim of this study is reporting a complex case of immune thrombocytopenic purpura (ITP) during pregnancy who has been diagnosed with COVID-19 as well as suspicion of HELLP syndrome. CASE PRESENTATION: A 24-year-old woman with a platelet count of 6000/mL and resistance to conventional therapies was referred. A day after starting 0.5 g/day of methylprednisolone for her, fever and a decrease in SpO2 presented. According to the paraclinical investigations, COVID-19 was diagnosed and the conventional COVID-19 treatments started for her (the methylprednisolone pulse stopped). Due to the increased liver enzymes and low platelet count, with suspicion of HELLP syndrome, cesarean section surgery was performed which resulted in a healthy neonate. Then, the methylprednisolone pulse was restarted for and she developed an increase in the platelet count. CONCLUSION: It is not clear how COVID-19 and pregnancy affected the patient's condition and the underlying disease; however, it seems the delivery and/or restarting the methylprednisolone pulses caused improvement in her condition.
Subject(s)
COVID-19/diagnosis , Methylprednisolone/administration & dosage , Pregnancy Complications, Hematologic/drug therapy , Pregnancy Complications, Infectious/diagnosis , Purpura, Thrombocytopenic, Idiopathic/drug therapy , Antiviral Agents/therapeutic use , COVID-19/complications , COVID-19/virology , Cesarean Section , Drug Resistance , Female , HELLP Syndrome/diagnosis , Humans , Infant, Newborn , Male , Platelet Count , Pregnancy , Pregnancy Complications, Hematologic/blood , Pregnancy Complications, Hematologic/diagnosis , Pregnancy Complications, Infectious/drug therapy , Pregnancy Complications, Infectious/virology , Pulse Therapy, Drug , Purpura, Thrombocytopenic, Idiopathic/blood , Purpura, Thrombocytopenic, Idiopathic/complications , Purpura, Thrombocytopenic, Idiopathic/diagnosis , SARS-CoV-2/isolation & purification , Treatment Outcome , Young Adult , COVID-19 Drug TreatmentSubject(s)
Betacoronavirus , Coronavirus Infections/blood , Pandemics , Pneumonia, Viral/blood , Pregnancy Complications, Hematologic/etiology , Pregnancy Complications, Infectious/blood , Thromboembolism/prevention & control , Thrombophilia/etiology , Anticoagulants/therapeutic use , Autoantibodies/blood , Betacoronavirus/isolation & purification , Betacoronavirus/physiology , Blood Proteins/analysis , COVID-19 , Cerebrovascular Disorders/etiology , Cerebrovascular Disorders/prevention & control , Contraindications, Drug , Coronavirus Infections/complications , Cytokine Release Syndrome/blood , Cytokine Release Syndrome/etiology , Disseminated Intravascular Coagulation/drug therapy , Disseminated Intravascular Coagulation/etiology , Endothelial Cells/virology , Female , Heparin, Low-Molecular-Weight/administration & dosage , Heparin, Low-Molecular-Weight/therapeutic use , Humans , Partial Thromboplastin Time , Plasma , Pneumonia, Viral/complications , Postpartum Hemorrhage/drug therapy , Postpartum Hemorrhage/therapy , Pregnancy , Pregnancy Complications, Hematologic/drug therapy , Puerperal Disorders/blood , Puerperal Disorders/drug therapy , Puerperal Disorders/etiology , SARS-CoV-2 , Thromboembolism/etiology , Thrombophilia/drug therapy , Tranexamic Acid/adverse effects , Tranexamic Acid/therapeutic useABSTRACT
BACKGROUND: The world's understanding of COVID-19 continues to evolve as the scientific community discovers unique presentations of this disease. This case report depicts an unexpected intraoperative coagulopathy during a cesarean section in an otherwise asymptomatic patient who was later found to have COVID-19. This case suggests that there may be a higher risk for intrapartum bleeding in the pregnant, largely asymptomatic COVID-positive patient with more abnormal COVID laboratory values. CASE: The case patient displayed D-Dimer elevations beyond what is typically observed among this hospital's COVID-positive peripartum population and displayed significantly more oozing than expected intraoperatively, despite normal prothrombin time, international normalized ratio, fibrinogen, and platelets. CONCLUSION: There is little published evidence on the association between D-Dimer and coagulopathy among the pregnant population infected with SARS-CoV-2. This case report contributes to the growing body of evidence on the effects of COVID-19 in pregnancy. A clinical picture concerning for intraoperative coagulopathy may be associated with SARS-CoV-2 infection during cesarean sections, and abnormal COVID laboratory tests, particularly D-Dimer, may help identify the patients in which this presentation occurs.