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1.
J Korean Med Sci ; 36(43): e306, 2021 Nov 08.
Article in English | MEDLINE | ID: covidwho-1566642

ABSTRACT

Immune thrombocytopenia (ITP) is an autoimmune condition characterized by platelet destruction through antibody-mediated mechanism. ITP is one of the manifestations of a coronavirus disease, as well as an adverse event occurring after vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Several cases of ITP have been described after vaccination with two mRNA-based vaccines-BTN162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna)-against SARS-CoV-2. Herein, we report a case of ITP occurring after vaccination with ChAdOx1 adenovirus vector nCoV-19 (AstraZeneca) vaccine in Korea. A 66-year-old woman presented with multiple ecchymoses on both upper and lower extremities and gingival bleeding, appearing 3 days after receiving the first dose of ChAdOx1 nCoV-19. Her laboratory results showed isolated severe thrombocytopenia without evidence of combined coagulopathy. She was diagnosed with ITP and successfully treated with high-dose dexamethasone and intravenous immunoglobulin. Clinical suspicion to identify vaccine-related ITP is important to promptly initiate appropriate treatment.


Subject(s)
COVID-19 Vaccines/administration & dosage , COVID-19/prevention & control , Ecchymosis/etiology , Purpura, Thrombocytopenic, Idiopathic/chemically induced , Vaccination/adverse effects , Aged , COVID-19/epidemiology , COVID-19 Vaccines/adverse effects , Dexamethasone/therapeutic use , Female , Humans , Immunoglobulins, Intravenous/therapeutic use , Periodontal Index , Purpura, Thrombocytopenic, Idiopathic/drug therapy , SARS-CoV-2
2.
Blood Coagul Fibrinolysis ; 32(7): 427-433, 2021 Oct 01.
Article in English | MEDLINE | ID: covidwho-1526210

ABSTRACT

Immune thrombocytopenia is a haematological, autoimmune disorder characterized by elevated platelet demolition due to the presence of antiplatelet autoantibodies derived from B cells and to an irregular, deficient process of platelets production in bone marrow. In this review, after a brief presentation of 'old' strategies used nowadays yet, we focused on new drugs used in the treatment of immune thrombocytopenia and their mechanism of action and posology, basing on the last scientific literature. The observation that CoViD-19 can be associated with immune thrombocytopenia is also put in evidence. Particular attention will be dedicated on the concept that the ideal treatment should represent a solution not only for the failure of normal processes of production and survival of platelets, but also it should improve quality of life of patients, with minimum adverse events. Anyway, despite enormous advances of the last years, further investigations are necessary in order to define scrupulously long-term efficacy of new molecules proposed.


Subject(s)
Purpura, Thrombocytopenic, Idiopathic/drug therapy , Aminopyridines/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , COVID-19/complications , COVID-19/immunology , Histocompatibility Antigens Class I , Humans , Immunosuppressive Agents/therapeutic use , Morpholines/therapeutic use , Protein Kinase Inhibitors/therapeutic use , Purpura, Thrombocytopenic, Idiopathic/etiology , Purpura, Thrombocytopenic, Idiopathic/immunology , Pyrimidines/therapeutic use , Receptors, Fc/antagonists & inhibitors , Receptors, Thrombopoietin/agonists , SARS-CoV-2/immunology , Syk Kinase/antagonists & inhibitors , Thiazoles/therapeutic use , Thiophenes/therapeutic use
4.
J Korean Med Sci ; 36(43): e306, 2021 Nov 08.
Article in English | MEDLINE | ID: covidwho-1506220

ABSTRACT

Immune thrombocytopenia (ITP) is an autoimmune condition characterized by platelet destruction through antibody-mediated mechanism. ITP is one of the manifestations of a coronavirus disease, as well as an adverse event occurring after vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Several cases of ITP have been described after vaccination with two mRNA-based vaccines-BTN162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna)-against SARS-CoV-2. Herein, we report a case of ITP occurring after vaccination with ChAdOx1 adenovirus vector nCoV-19 (AstraZeneca) vaccine in Korea. A 66-year-old woman presented with multiple ecchymoses on both upper and lower extremities and gingival bleeding, appearing 3 days after receiving the first dose of ChAdOx1 nCoV-19. Her laboratory results showed isolated severe thrombocytopenia without evidence of combined coagulopathy. She was diagnosed with ITP and successfully treated with high-dose dexamethasone and intravenous immunoglobulin. Clinical suspicion to identify vaccine-related ITP is important to promptly initiate appropriate treatment.


Subject(s)
COVID-19 Vaccines/administration & dosage , COVID-19/prevention & control , Ecchymosis/etiology , Purpura, Thrombocytopenic, Idiopathic/chemically induced , Vaccination/adverse effects , Aged , COVID-19/epidemiology , COVID-19 Vaccines/adverse effects , Dexamethasone/therapeutic use , Female , Humans , Immunoglobulins, Intravenous/therapeutic use , Periodontal Index , Purpura, Thrombocytopenic, Idiopathic/drug therapy , SARS-CoV-2
5.
BMJ Case Rep ; 14(11)2021 Nov 05.
Article in English | MEDLINE | ID: covidwho-1503863

ABSTRACT

Immune thrombocytopenic purpura (ITP) is characterised by isolated thrombocytopenia which may be idiopathic or due to a secondary aetiology. ITP is being increasingly recognised secondary to SARS-CoV-2 infection in the current pandemic. Here, we report a case of a five-and-a-half-year-old female child on maintenance chemotherapy for acute lymphoblastic leukaemia who subsequently developed ITP secondary to SARS-CoV-2 infection. Our patient had prolonged thrombocytopenia secondary to ITP, requiring the use of second-line agents including romiplostim and eltrombopag. This is a unique case where ITP was recognised secondary to SARS-CoV-2. In such cases of thrombocytopenia, ITP should be considered as an important differential in addition to relapse of leukaemia or thrombocytopenia due to chemotherapy drugs.


Subject(s)
COVID-19 , Precursor Cell Lymphoblastic Leukemia-Lymphoma , Purpura, Thrombocytopenic, Idiopathic , Child , Child, Preschool , Female , Humans , Neoplasm Recurrence, Local , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Purpura, Thrombocytopenic, Idiopathic/complications , Purpura, Thrombocytopenic, Idiopathic/diagnosis , Purpura, Thrombocytopenic, Idiopathic/drug therapy , SARS-CoV-2
7.
Am J Case Rep ; 22: e932557, 2021 Oct 21.
Article in English | MEDLINE | ID: covidwho-1478477

ABSTRACT

BACKGROUND COVID-19 is associated with many hematological manifestations, including lymphopenia and thrombosis. There have been rare occasions in which thrombocytopenia has been reported as the sole clinical presentation of COVID-19. CASE REPORT This is the case report of a 48-year-old Hispanic female patient with COVID-19 presenting as severe isolated thrombocytopenia. The patient presented to the Emergency Department with hemoptysis, spontaneous bruising, and excessive vaginal bleeding and also reported a recent flu-like illness. On examination, she was found to have bilateral subconjunctival hemorrhage, diffuse oral ulcers, epigastric abdominal tenderness, and ecchymosis on her chest, with scattered petechiae and palpable purpura on her lower limbs. Laboratory results were significant for a platelet count of 0×109 and an immature platelet fraction of 34.1%. Owing to clinical suspicion, the patient was tested for COVID-19, and her test result was positive. She was treated with intravenous immunoglobulin, prednisone, rituximab, vitamin C, and zinc. Upon achieving hemodynamic stability, she was discharged to follow up with a hematologist in the outpatient setting. CONCLUSIONS Hematological consequences of COVID-19 are becoming more prevalent. The mechanism behind this manifestation could be bone marrow failure, formation of platelet autoantibodies, or consumptive coagulopathy. These critical manifestations are necessary to manage, especially in severe forms like in our patient. Steroids and rituximab combination therapy have proven to be the most effective regimen.


Subject(s)
COVID-19 , Purpura, Thrombocytopenic, Idiopathic , Thrombocytopenia , Female , Humans , Middle Aged , Purpura, Thrombocytopenic, Idiopathic/complications , Purpura, Thrombocytopenic, Idiopathic/diagnosis , Purpura, Thrombocytopenic, Idiopathic/drug therapy , Rituximab , SARS-CoV-2
9.
BMJ Case Rep ; 14(9)2021 Sep 27.
Article in English | MEDLINE | ID: covidwho-1440813

ABSTRACT

A 40-year-old man with no cardiac history presented with central chest pain 8 days after receiving the ChAdOx1 nCov-19 vaccine against COVID-19. Initial blood tests demonstrated a thrombocytopaenia (24×109 µg/L) and a raised d-dimer (>110 000 µg/L), and he was urgently transferred to our tertiary referral central for suspected vaccine-induced immune thrombocytopaenia and thrombosis (VITT). He developed dynamic ischaemic electrocardiographic changes with ST elevation, a troponin of 3185 ng/L, and regional wall motion abnormalities. An occlusion of his left anterior descending coronary artery was seen on CT coronary angiography. His platelet factor-4 (PF-4) antibody returned strongly positive. He was urgently treated for presumed VITT with intravenous immunoglobulin, methylprednisolone and plasma exchange, but remained thrombocytopaenic and was initiated on rituximab. Argatroban was used for anticoagulation for his myocardial infarction while he remained thrombocytopaenic. After 6 days, his platelet count improved, and his PF-4 antibody level, troponin and d-dimer fell. He was successfully discharged after 14 days.


Subject(s)
COVID-19 , Myocardial Infarction , Purpura, Thrombocytopenic, Idiopathic , ST Elevation Myocardial Infarction , Thrombocytopenia , Thrombosis , Vaccines , Adult , COVID-19 Vaccines , Electrocardiography , Humans , Male , Purpura, Thrombocytopenic, Idiopathic/chemically induced , Purpura, Thrombocytopenic, Idiopathic/drug therapy , SARS-CoV-2 , ST Elevation Myocardial Infarction/etiology
10.
Lancet ; 398(10306): 1147-1156, 2021 09 25.
Article in English | MEDLINE | ID: covidwho-1437625

ABSTRACT

BACKGROUND: A new syndrome of vaccine-induced immune thrombotic thrombocytopenia (VITT) has emerged as a rare side-effect of vaccination against COVID-19. Cerebral venous thrombosis is the most common manifestation of this syndrome but, to our knowledge, has not previously been described in detail. We aimed to document the features of post-vaccination cerebral venous thrombosis with and without VITT and to assess whether VITT is associated with poorer outcomes. METHODS: For this multicentre cohort study, clinicians were asked to submit all cases in which COVID-19 vaccination preceded the onset of cerebral venous thrombosis, regardless of the type of vaccine, interval between vaccine and onset of cerebral venous thrombosis symptoms, or blood test results. We collected clinical characteristics, laboratory results (including the results of tests for anti-platelet factor 4 antibodies where available), and radiological features at hospital admission of patients with cerebral venous thrombosis after vaccination against COVID-19, with no exclusion criteria. We defined cerebral venous thrombosis cases as VITT-associated if the lowest platelet count recorded during admission was below 150 × 109 per L and, if the D-dimer was measured, the highest value recorded was greater than 2000 µg/L. We compared the VITT and non-VITT groups for the proportion of patients who had died or were dependent on others to help them with their activities of daily living (modified Rankin score 3-6) at the end of hospital admission (the primary outcome of the study). The VITT group were also compared with a large cohort of patients with cerebral venous thrombosis described in the International Study on Cerebral Vein and Dural Sinus Thrombosis. FINDINGS: Between April 1 and May 20, 2021, we received data on 99 patients from collaborators in 43 hospitals across the UK. Four patients were excluded because they did not have definitive evidence of cerebral venous thrombosis on imaging. Of the remaining 95 patients, 70 had VITT and 25 did not. The median age of the VITT group (47 years, IQR 32-55) was lower than in the non-VITT group (57 years; 41-62; p=0·0045). Patients with VITT-associated cerebral venous thrombosis had more intracranial veins thrombosed (median three, IQR 2-4) than non-VITT patients (two, 2-3; p=0·041) and more frequently had extracranial thrombosis (31 [44%] of 70 patients) compared with non-VITT patients (one [4%] of 25 patients; p=0·0003). The primary outcome of death or dependency occurred more frequently in patients with VITT-associated cerebral venous thrombosis (33 [47%] of 70 patients) compared with the non-VITT control group (four [16%] of 25 patients; p=0·0061). This adverse outcome was less frequent in patients with VITT who received non-heparin anticoagulants (18 [36%] of 50 patients) compared with those who did not (15 [75%] of 20 patients; p=0·0031), and in those who received intravenous immunoglobulin (22 [40%] of 55 patients) compared with those who did not (11 [73%] of 15 patients; p=0·022). INTERPRETATION: Cerebral venous thrombosis is more severe in the context of VITT. Non-heparin anticoagulants and immunoglobulin treatment might improve outcomes of VITT-associated cerebral venous thrombosis. Since existing criteria excluded some patients with otherwise typical VITT-associated cerebral venous thrombosis, we propose new diagnostic criteria that are more appropriate. FUNDING: None.


Subject(s)
COVID-19 Vaccines/adverse effects , Intracranial Thrombosis/epidemiology , Purpura, Thrombocytopenic, Idiopathic/epidemiology , Vaccination/adverse effects , Adult , COVID-19 Vaccines/immunology , Cohort Studies , Female , Fibrin Fibrinogen Degradation Products , Humans , Intracranial Thrombosis/drug therapy , Intracranial Thrombosis/mortality , Male , Middle Aged , Platelet Count , Purpura, Thrombocytopenic, Idiopathic/drug therapy , SARS-CoV-2 , United Kingdom/epidemiology , Venous Thrombosis/drug therapy , Venous Thrombosis/epidemiology
11.
Am J Case Rep ; 22: e931517, 2021 Sep 02.
Article in English | MEDLINE | ID: covidwho-1413537

ABSTRACT

BACKGROUND Immune thrombocytopenia (ITP) is rare in infants under 1 year old. Bleeding often occurs when the platelet count is <20 000/uL. The disease can progress because of accompanying COVID-19 disease. CASE REPORT A 9-month-old boy, weighing 8.5 kg, came to the hospital with petechiae on the forehead, cheeks, mouth, and extremities. The patient had rhinorrhea for 3 days previously and was febrile, pale, weak, and could not drink. He had the measles-rubella vaccination 19 days prior. Physical examination showed no abnormalities of the eyes, ears, nose, throat, and mouth. Heart and lungs were within normal limits, with no organomegaly, lymphadenopathy, or congenital anomaly of the abdomen. Laboratory examination showed hemoglobin, 12.7 g/dL; leukocytes, 7420/uL; platelet count, 16 000/uL; and hematocrit, 37.9%. Erythrocyte sedimentation rate was 14 mm at 1 h and 21 mm at 2 h. Peripheral blood smear showed normal RBC morphology, normal leukocytes, and few platelets. IgG was reactive and IgM was nonreactive on rapid antibody test. RT-PCR was positive for SARS-COV-2. Chest-X-ray showed pneumonia. The diagnosis was newly diagnosed ITP with COVID-19. Patient was treated with 30 mg/kg body weight/day of IV methylprednisolone for 3 days (250 mg); then 20 mg/kg body weight/day (175 mg) orally for 4 days in 3 divided doses. Azithromycin 100 mg/day, zinc 20 mg/day, and vitamin C 50 mg/day orally were also given. CONCLUSIONS COVID-19 screening is highly recommended during this pandemic to identify it as a potential cause of childhood ITP. Megadose methylprednisolone had an excellent response in alleviating ITP with confirmed COVID-19 in an infant.


Subject(s)
COVID-19 , Purpura, Thrombocytopenic, Idiopathic , Humans , Infant , Male , Methylprednisolone/therapeutic use , Pandemics , Purpura, Thrombocytopenic, Idiopathic/diagnosis , Purpura, Thrombocytopenic, Idiopathic/drug therapy , SARS-CoV-2
12.
BMC Pregnancy Childbirth ; 21(1): 567, 2021 Aug 18.
Article in English | MEDLINE | ID: covidwho-1365335

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/drug therapy , 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
13.
BMJ Case Rep ; 14(7)2021 Jul 30.
Article in English | MEDLINE | ID: covidwho-1334542

ABSTRACT

A 26-year-old woman was sent to the emergency room by her primary care physician for a new petechial rash and thrombocytopenia 2 weeks after receiving the Moderna mRNA-1273 SARS-CoV-2 vaccine. Her hospital course was complicated by transaminitis. Her platelet count improved to normal on hospital day 5 after receiving intravenous steroids and intravenous immunoglobulin to treat her suspected diagnosis of immune thrombocytopenic purpura. Extensive workup for her thrombocytopenia and transaminitis was unremarkable including ruling out infectious, autoimmune and toxic causes. A liver biopsy was unrevealing and her transaminitis was improved on discharge. Although not proven, the temporal relationship of her vaccination with thrombocytopenia and abnormal liver enzymes points towards the Moderna mRNA-1273 SARS-CoV-2 vaccine as the most likely inciting factor.


Subject(s)
COVID-19 , Purpura, Thrombocytopenic, Idiopathic , Adult , COVID-19 Vaccines , Female , Humans , Liver , Purpura, Thrombocytopenic, Idiopathic/diagnosis , Purpura, Thrombocytopenic, Idiopathic/drug therapy , SARS-CoV-2
14.
BMJ Case Rep ; 14(7)2021 Jul 20.
Article in English | MEDLINE | ID: covidwho-1319391

ABSTRACT

A 61-year-old woman who had tested positive for COVID-19 in the community 5 days prior to admission presented with new onset severe headache and mild shortness of breath. She had an acute reduction in her platelet counts from 153×109/L to 5×109/L. She was diagnosed with immune thrombocytopenia purpura and after treatment with intravenous immunoglobulin, her platelet count increased to 15×109/L. Due to nonresolving headache, she had a magnetic resonance venogram, which showed bilateral internal jugular vein thrombosis. She was discharged from hospital and followed up in Haematology and Neurology clinics. Her platelet count returned to normal range 7 days later. She was commenced on anticoagulation for thrombosis.


Subject(s)
COVID-19 , Purpura, Thrombocytopenic, Idiopathic , Thrombosis , Female , Humans , Jugular Veins/diagnostic imaging , Middle Aged , Purpura, Thrombocytopenic, Idiopathic/complications , Purpura, Thrombocytopenic, Idiopathic/diagnosis , Purpura, Thrombocytopenic, Idiopathic/drug therapy , SARS-CoV-2
17.
Sci Prog ; 104(2): 368504211025927, 2021.
Article in English | MEDLINE | ID: covidwho-1268172

ABSTRACT

With over 600 million coronavirus (COVID-19) vaccine doses administered globally, adverse events are constantly monitored. Recently however, reports of thrombosis and thrombocytopenia following vaccination with the ChAdOx1 nCoV-19 vaccine have emerged. This paper aims to review the available literature and guidelines pertaining to vaccine-induced immune thrombotic thrombocytopenia (VITT) and the proposed guidelines, while offering a potential approach that unifies the available evidence. While the risk of VITT remains extremely low and the benefits outweigh the risks, experimental studies are needed to clarify the pathophysiology behind VITT and possibly decrease the risk of thrombosis and other adverse events occurring. However, treatment should not be delayed in suspected cases, and IV immunoglobulin and non-heparin anticoagulation should be initiated.


Subject(s)
Anticoagulants/therapeutic use , COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , Immunoglobulins, Intravenous/therapeutic use , Purpura, Thrombocytopenic, Idiopathic/drug therapy , Thrombosis/drug therapy , Antithrombins/therapeutic use , Autoantibodies/blood , Biomarkers/blood , COVID-19/epidemiology , COVID-19/immunology , Factor Xa Inhibitors/therapeutic use , Fibrin Fibrinogen Degradation Products/metabolism , Fondaparinux/therapeutic use , Heparin/adverse effects , Humans , Practice Guidelines as Topic , Purpura, Thrombocytopenic, Idiopathic/blood , Purpura, Thrombocytopenic, Idiopathic/chemically induced , Purpura, Thrombocytopenic, Idiopathic/pathology , SARS-CoV-2/immunology , SARS-CoV-2/pathogenicity , Thrombosis/blood , Thrombosis/chemically induced , Thrombosis/pathology
19.
Lupus ; 30(9): 1515-1521, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1247525

ABSTRACT

Immune thrombocytopenia, also known as immune thrombocytopenic purpura (ITP), has been reported as an important complication related to COVID-19.We present a 49-year-old male patient with systemic lupus erythematosus with lupus nephritis, antiphospholipid syndrome and history of ITP who developed an ITP flare in the context of COVID-19. He had no bleeding manifestations and had a good response to prednisone treatment.We review the characteristics of the cases reported to date in the literature, with an analysis of 57 patients. Mean age was 56 years (±19.6 SD), and 50.9% were male. This was the first episode of ITP in most of the patients (86.05%), with SARS-CoV-2 acting as the initial trigger. We found that ITP flares may appear in both mild and severe COVID-19 cases. They also appeared at any time during the course of the disease, 48.2% of patients developed it during hospitalization, while it was diagnosed at admission in the rest of the cases. Platelet counts were significantly lower than other ITP series, with a median nadir platelet count of 8 × 109/L (IQR 2-17.75 × 109/L). These patients show a higher bleeding rate (61.4%) compared with other ITP series. They also show a better response to treatment, with good response to the first line therapies in 76.9% of them. The most common first-line treatment was intravenous immunoglobulin (IVIG), used alone or combined with corticosteroids in 40.4% and 32.7% of cases respectively, while 25% of patients received only corticosteroids.Our review suggests that COVID-19-related ITP can be seen even in previously healthy patients. Clinicians must be aware that ITP may appear both in mild and severe COVID-19, at any time during its course. Given that this kind of ITP seems to be associated with a higher bleeding risk, its diagnosis in a clinical scenario such as COVID-19, where anticoagulant therapy is frequently used, may be critical. Treatment with IVIG and/or corticoids is often effective.


Subject(s)
COVID-19/complications , Prednisone/administration & dosage , Purpura, Thrombocytopenic, Idiopathic/diagnosis , Glucocorticoids/administration & dosage , Humans , Immunoglobulins, Intravenous/administration & dosage , Lupus Erythematosus, Systemic/complications , Male , Middle Aged , Platelet Count , Purpura, Thrombocytopenic, Idiopathic/drug therapy , Purpura, Thrombocytopenic, Idiopathic/virology , Treatment Outcome
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