Severe Thrombocytopenic Purpura Associated with COVID-19 in a Pediatric Patient

Figures & data

Table 1 Laboratory Findings Before Treatment with IVIG

Laboratory Data	Normal Range	D-2	D-3	D-4	D-5
RBC	4.0–5.5×10^6/μL	4.84	4.25	4.40	4.68
Hemoglobin	10.0–15.5 g/dL	13.0	11.5	11.9	12.5
Hematocrit	32–44%	37.5	33.2	34.3	36.2
Platelets	150–400×10^3/μL	0	0	0	0
WBC	4.00–10.00×10^3/μL	2.05	6.49	9.80	11.65
Ne	30.0–65.0%	59.5	53.3	66.0	75.9
Ly	20.0–55.0%	37.1	33.3	23.6	19.0
Mo	5.5–10.0%	3.4	13.4	10.4	5.0
Fibrinogen	1.8–3.5 g/L	3.27	2.11	2.52	–
D-dimers	<0.55 μg/mL	4.28	2.12	1.09	–
AST	0–32 U/L	108.7	–	17.4	–
ALT	0–33 U/L	233.3	–	10.1	–
Serum urea	0–50 mg/dL	124.9	–	24.1	–
Creatinine	0.40–0.60 mg/dL	2.37	–	0.43	–
Random glucose level	74–106 mg/dL	126	–	112	–
Total bilirubin	0–1.2 mg/dL	0.63	–	0.29	–
Direct bilirubin	0–0.2 mg/dL	0.38	–	0.15	–
Ferritin	15–150 ug/L	6335.96	–	66.47	–
CRP	0–5 mg/L	116.73	–	0.30	–
Procalcitonin	0–0.5 ng/mL	0.04	–	0.03	–
IL-6	0–7/pg/mL	<1.50	–	<1.50	–
Peripheric blood smear		Leukopenia, lymphopenia, absent platelets	Absent platelets, scattered, reactive lymphocytes (monocidoid-looking with intense basophilic cytoplasm)	Absent platelets, monocytosis	Scattered, low number of platelets, erythrocyte, and granulocyte line of normal morphology

Abbreviations: WBC, white blood cells; RBC, red blood cells; Ne, neutrophils; Ly, lymphocytes; Mo, monocytes; AST, aspartate aminotransferase; ALT, alanine aminotransferase; CRP, Creactive protein; IL-6, interleukin 6; D, day.

Figure 1 Peripheral blood smear with normal RBC morphology and absent platelets.

Figure 2 Patient with wet purpura and petechias in the first 48 h since hospital admission.

Figure 3 Ecchymosis in the first 48 h since hospital admission.

Table 2 Laboratory Findings After Initiating Treatment with IVIG

Laboratory Data	Normal Range	D-6	D-7	D-8	D-10
RBC	4.0–5.5×10^6/μL	4.88	4.36	4.58	4.93
Hemoglobin	10.0–15.5 g/dL	13.0	11.7	12.3	13.3
Hematocrit	32–44%	37.3	33.6	35.2	38.1
Platelets	150–400×10^3/μL	56	133	266	293
WBC	4.00–10.00×10^3/μL	10.09	8.28	11.6	7.52
Ne	30.0–65.0%	75.4	63.1	64.5	38.9
Ly	20.0–55.0%	16.6	23.3	22.0	45.7
Mo	5.5–10.0%	7.9	13.6	13.5	10.0
Fibrinogen	1.8–3.5 g/L	–	–	–	2.60
D-dimers	<0.55 μg/mL	–	–	0.62	0.51
AST	0–32 U/L	–	16.1	–	23.4
ALT	0–33 U/L	–	10.7	–	12
Serum urea	0–50 mg/dL	–	27.8	–	24.8
Creatinine	0.40–0.60 mg/dL	–	0.48	–	0.51
Random glucose level	74–106 mg/dL	–	–	–	91
Total bilirubin	0–1.2 mg/dL	–	0.46	–	0.53
Direct bilirubin	0–0.2 mg/dL	–	0.12	–	0.19
Ferritin	15–150 ug/L	–	–	–	150.0
CRP	0–5 mg/L	–	0.20	–	0.74
Procalcitonin	0–0.5 ng/mL	–	–	–	0.08
IL-6	0–7/pg/mL	–	–	–	<1.50 pg/mL
Peripheric blood smear		Scattered, low number of platelets, normal RBC, normal WBC	–	–	–
RT-PCR SARS-CoV-2	Negative	–	–	–	Negative

Abbreviations: WBC, white blood cells; RBC, red blood cells; Ne, neutrophils; Ly, lymphocytes; Mo, monocytes; AST, aspartate aminotransferase; ALT, alanine aminotransferase; CRP, C-reactive protein; IL-6, interleukin 6; D, day.

Figure 4 Patient on D-8 of hospital admission, with clinical improvement of wet purpura.

Figure 5 Clinical improvement of ecchymosis.