View source for COVID-19-associated thrombocytopenia

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{{SK}} Decrease in platelet count in COVID 19, effects of thrombocytopenia in COVID 19, thrombocytopenia complications of COVID 19

==Overview==
[[COVID-19|Coronavirus disease 2019 (COVID-19)]] is caused by a novel [[coronavirus]] called [[SARS-CoV-2]], which caused a respiratory illness [[outbreak]] that was first detected in Wuhan, China. [[Thrombocytopenia]] in [[COVID-19]] infection is more common in patients with severe infection and it has been reported that [[thrombocytopenia]] upon admission for [[COVID-19]] infection is associated with poor outcome and [[mortality]]. [[Thrombocytopenia]] is defined by platelet count <150 x <math>10^9</math>/L on [[Complete blood count|complete blood count (CBC)]]. The [[pathogenesis]] of [[thrombocytopenia]] in [[COVID-19]] infection is due to several factors such as: infection of [[bone marrow]], [[COVID-19-associated cytokine storm|cytokine storm]] caused by the [[COVID-19]] infection, increase in [[Autoantibody|autoantibodies]] and [[Immune complex|immune complexes]], [[lung]] injury which causes [[megakaryocyte]] fragmentation, and decrease in [[platelets]] which may be due to the activation of [[Platelet|platelets]] that result in [[platelet]] [[aggregation]]. 

==Historical Perspective==
* [[COVID-19|Coronavirus disease 2019 (COVID-19)]] is caused by a novel [[coronavirus]] called [[SARS-CoV-2]], which caused a respiratory illness [[outbreak]] that was first detected in Wuhan, China.<ref>{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/about/index.html|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref><ref name="LuCui2020">{{cite journal|last1=Lu|first1=Jian|last2=Cui|first2=Jie|last3=Qian|first3=Zhaohui|last4=Wang|first4=Yirong|last5=Zhang|first5=Hong|last6=Duan|first6=Yuange|last7=Wu|first7=Xinkai|last8=Yao|first8=Xinmin|last9=Song|first9=Yuhe|last10=Li|first10=Xiang|last11=Wu|first11=Changcheng|last12=Tang|first12=Xiaolu|title=On the origin and continuing evolution of SARS-CoV-2|journal=National Science Review|year=2020|issn=2095-5138|doi=10.1093/nsr/nwaa036}}</ref>

* On January 30, 2020, the [[outbreak]] was declared a Public Health Emergency of International Concern.
* On March 12, 2020, the [[COVID-19]] outbreak was declared a [[pandemic]] by the [[World Health Organization|World Health Organization (WHO)]].

==Classification==
*[[Thrombocytopenia]] in general is defined by [[platelet]] count <150 x <math>10^9</math>/L on [[complete blood count]] ([[Complete blood count|CBC]]).<ref name="pmid28030481" />
*Classification of [[thrombocytopenia]] in general by [[platelet]] count is:<ref name="pmid22534274">{{cite journal| author=Gauer RL, Braun MM| title=Thrombocytopenia. | journal=Am Fam Physician | year= 2012 | volume= 85 | issue= 6 | pages= 612-22 | pmid=22534274 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22534274  }} </ref>
**Mild: between 70,000 and 150,000 x <math>10^9</math>/L
**Severe: less than 20,000 x <math>10^9</math>/L
*In general:<ref name="pmid22534274" />
**Most [[Thrombocytopenia|thrombocytopenic]] patients are [[asymptomatic]] if the [[platelet]] count is 50,000 x <math>10^9</math>/L or greater.
**[[Thrombocytopenia|Thrombocytopenic]] patients with [[platelet]] count between 30 and 50 x <math>10^9</math>/L rarely have [[purpura]], but may have bleeding with [[Physical trauma|trauma]].
**[[Thrombocytopenia|Thrombocytopenic]] patients with [[platelet]] count between 10 and 30 x <math>10^3</math>/L may have bleeding with minor [[trauma]].
**[[Thrombocytopenia|Thrombocytopenic]] patients with [[platelet]] count less than 10 x <math>10^3</math>/L have increased risk for spontaneous [[bleeding]], [[Petechia|petechiae]], and [[Bruise|bruising]].
**In [[Thrombocytopenia|thrombocytopenic]] patients, spontaneous bleeding, which is an [[emergency]], usually occurs in patients with [[platelet]] counts less than 5 x <math>10^3</math>/L .

==Pathophysiology==
The [[pathogenesis]] of [[thrombocytopenia]] in [[COVID-19]] infection is due to several factors:<ref name="pmid32296910">{{cite journal| author=Xu P, Zhou Q, Xu J| title=Mechanism of thrombocytopenia in COVID-19 patients. | journal=Ann Hematol | year= 2020 | volume= 99 | issue= 6 | pages= 1205-1208 | pmid=32296910 | doi=10.1007/s00277-020-04019-0 | pmc=7156897 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32296910  }} </ref><ref name="pmid16019455">{{cite journal| author=Yang M, Ng MH, Li CK| title=Thrombocytopenia in patients with severe acute respiratory syndrome (review). | journal=Hematology | year= 2005 | volume= 10 | issue= 2 | pages= 101-5 | pmid=16019455 | doi=10.1080/10245330400026170 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16019455  }} </ref><ref name="pmid1350662">{{cite journal| author=Yeager CL, Ashmun RA, Williams RK, Cardellichio CB, Shapiro LH, Look AT | display-authors=etal| title=Human aminopeptidase N is a receptor for human coronavirus 229E. | journal=Nature | year= 1992 | volume= 357 | issue= 6377 | pages= 420-2 | pmid=1350662 | doi=10.1038/357420a0 | pmc=7095410 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1350662  }} </ref><ref name="pmid11551503">{{cite journal| author=Nardi M, Tomlinson S, Greco MA, Karpatkin S| title=Complement-independent, peroxide-induced antibody lysis of platelets in HIV-1-related immune thrombocytopenia. | journal=Cell | year= 2001 | volume= 106 | issue= 5 | pages= 551-61 | pmid=11551503 | doi=10.1016/s0092-8674(01)00477-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11551503  }} </ref><ref name="pmid28329764">{{cite journal| author=Lefrançais E, Ortiz-Muñoz G, Caudrillier A, Mallavia B, Liu F, Sayah DM | display-authors=etal| title=The lung is a site of platelet biogenesis and a reservoir for haematopoietic progenitors. | journal=Nature | year= 2017 | volume= 544 | issue= 7648 | pages= 105-109 | pmid=28329764 | doi=10.1038/nature21706 | pmc=5663284 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28329764  }} </ref><ref name="pmid32495027">{{cite journal| author=Liu X, Zhang R, He G| title=Hematological findings in coronavirus disease 2019: indications of progression of disease. | journal=Ann Hematol | year= 2020 | volume=  | issue=  | pages=  | pmid=32495027 | doi=10.1007/s00277-020-04103-5 | pmc=7266734 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32495027  }} </ref>

* Decrease in primary [[platelet]] production due to infection of [[bone marrow]] cells by [[Coronavirus|coronaviruses]] and inhibition of [[bone marrow]] growth, which lead to abnormal [[hematopoietic]] function.
*Decrease in [[Platelet|platelets]] may also be due to a [[COVID-19-associated cytokine storm|cytokine storm]] caused by the [[COVID-19]] infection which results in the destruction of [[bone marrow]] [[Progenitor cell|progenitor cells]].
* Increase in [[platelet]] destruction due to an increase in [[Autoantibody|autoantibodies]] and [[Immune complex|immune complexes]].
* Decrease in circulating [[platelet]] due to [[lung]] injury which causes [[megakaryocyte]] fragmentation and decreases platelet production, because the lung is a reservoir for [[megakaryocyte]] and [[hematopoietic]] [[Progenitor cell|progenitor cells]] and has a role in [[platelet]] production.
*In addition, a decrease in [[platelets]] may be due to the activation of [[Platelet|platelets]] that result in [[platelet]] [[aggregation]] and formation of micro-[[thrombus]] which increase [[platelet]] consumption.

Summary of the mechanisms involved in [[thrombocytopenia]] in [[COVID-19]] infection:<ref name="pmid32296910" />[[ File:Covid 19 coagulation.jpg|center|800px]]

==Causes==
* [[COVID-19|Coronavirus disease 2019 (COVID-19)]] is caused by a novel [[coronavirus]] called [[SARS-CoV-2]]  and is the cause of [[thrombocytopenia]] in [[COVID-19]] infection.

==Differentiating Thrombocytopenia from other Diseases==
* [[COVID-19|Coronavirus disease 2019 (COVID-19)]]  may cause [[thrombocytopenia]]. The differential diagnosis to consider for [[thrombocytopenia]] in general include:<ref name="pmid27866576">{{cite journal| author=Lee EJ, Lee AI| title=Thrombocytopenia. | journal=Prim Care | year= 2016 | volume= 43 | issue= 4 | pages= 543-557 | pmid=27866576 | doi=10.1016/j.pop.2016.07.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27866576  }} </ref>
**[[Pseudothrombocytopenia]]  
** Inherited [[Thrombocytopenia|thrombocytopenias]] ([[Bernard-Soulier syndrome]], [[Wiskott-Aldrich syndrome]], and [[thrombocytopenia]] with absent radii)  
**[[Immune thrombocytopenic purpura|Immune thrombocytopenic purpura (ITP)]] and drug-induced [[Idiopathic thrombocytopenic purpura|ITP]] (such as [[quinine]], [[Non-steroidal anti-inflammatory drug|NSAIDs]], [[glycoprotein IIb/IIIa inhibitors]])
**[[Heparin-induced thrombocytopenia|Heparin-induced thrombocytopenia (HIT)]]
**[[Thrombotic thrombocytopenic purpura|Thrombotic thrombocytopenic purpura (TTP)]]/[[Hemolytic uremic syndrome|hemolytic uremic syndrome (HUS)]]
** Drug-induced [[Thrombotic thrombocytopenic purpura|TTP]] (such as [[mitomycin]] C, [[gemcitabine]], [[oxaliplatin]])
**[[Disseminated intravascular coagulation|Disseminated intravascular coagulation (DIC)]]
**[[Hematologic]] disorders ([[lymphoma]], [[leukemia]], [[myelodysplastic syndrome]])
**[[Post-transfusion purpura]]
**[[Autoimmune]]-related [[thrombocytopenia]] (such as [[Systemic lupus erythematosus|systemic lupus erythematosus (SLE)]], [[Common variable immunodeficiency|common variable immunodeficiency (CVID)]], [[Antiphospholipid syndrome|antiphospholipid antibody syndrome]],[[thyroid]] disease)
**[[Tumor]] infiltration of bone marrow
**[[Bone marrow]] failure (such as [[aplastic anemia]], [[fanconi anemia]], and [[diamond-Blackfan anemia]])
**[[Liver]] disease
**[[Splenomegaly]]
**Infections ([[Epstein Barr virus|Epstein-Barr virus]], cytomegalovirus, [[hepatitis C]], [[Human Immunodeficiency Virus (HIV)|HIV]], [[parvovirus B19]], [[Helicobacter pylori|H pylori]])
** Drugs ([[Antibiotic|antibiotics]], [[alcohol]], [[chemotherapy]], [[radiation]])
**[[Folate deficiency]] or [[vitamin B12 deficiency]]
**Mechanical destruction (such as [[cardiopulmonary bypass]], [[intra-aortic balloon pump]])  

For detailed differential diagnosis of [[thrombocytopenia]] click [[Thrombocytopenia differential diagnosis|here]] 

==Epidemiology and Demographics==
*[[Thrombocytopenia]] is seen in 36.2% of all patients with COVID-19 infection.<ref name="pmid32109013" />
*[[Thrombocytopenia]]<nowiki/> is seen in 57.7% of patients with severe [[COVID-19]] infection compared to 31.6 % of patients with non-severe infection.<ref name="pmid32109013">{{cite journal| author=Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX | display-authors=etal| title=Clinical Characteristics of Coronavirus Disease 2019 in China. | journal=N Engl J Med | year= 2020 | volume= 382 | issue= 18 | pages= 1708-1720 | pmid=32109013 | doi=10.1056/NEJMoa2002032 | pmc=7092819 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32109013  }} </ref>

==Risk Factors==
* [[Thrombocytopenia]] in [[COVID-19]] infection is more common is patients with severe infection compared to patients with non-severe infection.<ref name="pmid32109013" />

==Screening==
* It has been reported that [[thrombocytopenia]] upon admission for [[COVID-19]] infection is associated with severe disease and [[mortality]].<ref name="pmid32557535">{{cite journal| author=Maquet J, Lafaurie M, Sommet A, Moulis G, Covid-Clinic-Toul investigators group. Alvarez M | display-authors=etal| title=Thrombocytopenia is independently associated with poor outcome in patients hospitalized for COVID-19. | journal=Br J Haematol | year= 2020 | volume=  | issue=  | pages=  | pmid=32557535 | doi=10.1111/bjh.16950 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32557535  }} </ref>
* However, there is insufficient evidence to recommend routine [[Screening (medicine)|screening]] and monitoring of [[thrombocytopenia]] for predicting disease progression in patients with [[COVID-19]] infection and further studies are required.<ref name="pmid32535232">{{cite journal| author=Zhang Y, Zeng X, Jiao Y, Li Z, Liu Q, Ye J | display-authors=etal| title=Mechanisms involved in the development of thrombocytopenia in patients with COVID-19. | journal=Thromb Res | year= 2020 | volume= 193 | issue=  | pages= 110-115 | pmid=32535232 | doi=10.1016/j.thromres.2020.06.008 | pmc=7274097 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32535232  }} </ref>

==Natural History, Complications, and Prognosis==

=== Natural History ===
* [[Thrombocytopenia]] is associated with an increased risk for severe [[COVID-19]] infection (threefold).<ref name="pmid32178975">{{cite journal| author=Lippi G, Plebani M, Henry BM| title=Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis. | journal=Clin Chim Acta | year= 2020 | volume= 506 | issue=  | pages= 145-148 | pmid=32178975 | doi=10.1016/j.cca.2020.03.022 | pmc=7102663 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32178975  }} </ref>

=== Complications ===
*Complications of [[thrombocytopenia]] in patients with severe [[COVID-19]] infection may include:<ref name="pmid32535232" />
**[[Disseminated intravascular coagulation|Disseminated intravascular coagulation (DIC)]]
**[[Multiple organ dysfunction syndromes]]
**Death

=== Prognosis ===
*It has been reported that [[thrombocytopenia]] upon admission for [[COVID-19]] infection is independently and strongly associated with poor outcome and [[mortality]].<ref name="pmid32557535" />

==Diagnosis==
===Diagnostic Study of Choice===
*The [[diagnostic study of choice]] for [[thrombocytopenia]] is [[complete blood count]] ([[Complete blood count|CBC]]).

*[[Thrombocytopenia]] in general is defined by [[platelet count]] <150 x <math>10^9</math>/L on [[Complete blood count|CBC]].<ref name="pmid28030481" />
*The median [[platelet]] count in [[COVID-19]] patients with [[thrombocytopenia]] is 137,500 and 172,000 x <math>10^9</math>/L in severe and non-severe infection, respectively.<ref name="pmid32109013" />

===History and Symptoms===
*The median [[platelet]] count in [[COVID-19]] patients with [[thrombocytopenia]] is 137,500 and 172,000 x <math>10^9</math>/L in severe and non-severe infection, respectively.<ref name="pmid32109013" />
* In general, in [[Thrombocytopenia|thrombocytopenic]] patients, most patients are asymptomatic if the platelet count is 50,000 x <math>10^9</math>/L or greater.<ref name="pmid22534274" />

* In general, in [[Thrombocytopenia|thrombocytopenic]] patients should be questioned about:<ref name="pmid28030481" /><ref name="pmid22534274" />
**[[Bruise|Bruising]] or [[Petechia|petechiae]]
**[[Bleeding]] ([[melena]], [[epistaxis]], [[menorrhagia]], [[hematuria]], prolonged bleeding after procedures, [[Gingiva|gingival]] bleeding and blood in [[sputum]])  
** Past medical history  
**[[Family history]]
**[[Medication|Medications]] history
**[[Vaccination|Immunization]] history
** Changes in vision
**[[Rash]]
**[[Fever]]
** Recent travel
**[[Blood transfusion|Transfusion]] history

===Physical Examination===
* The median [[platelet]] count in [[COVID-19]] patients with [[thrombocytopenia]] is 137,500 and 172,000 x <math>10^9</math>/L in severe and non-severe infection, respectively.<ref name="pmid32109013" />
* In general, in [[Thrombocytopenia|thrombocytopenic]] patients, most patients are asymptomatic if the [[platelet]] count is 50,000 x <math>10^9</math>/L or greater.<ref name="pmid22534274" />
* The [[physical examination]] in patients with [[thrombocytopenia]] in general should include checking for:<ref name="pmid28030481">{{cite journal| author=Greenberg EM| title=Thrombocytopenia: A Destruction of Platelets. | journal=J Infus Nurs | year= 2017 | volume= 40 | issue= 1 | pages= 41-50 | pmid=28030481 | doi=10.1097/NAN.0000000000000204 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28030481  }} </ref>
** Bleeding ([[epistaxis]], bloody [[sputum]], [[Gingiva|gingival]] [[bleeding]], [[menorrhagia]], heavy [[bleeding]] after invasive procedures or [[childbirth]])<ref name="pmid24729754">{{cite journal| author=Ghoshal K, Bhattacharyya M| title=Overview of platelet physiology: its hemostatic and nonhemostatic role in disease pathogenesis. | journal=ScientificWorldJournal | year= 2014 | volume= 2014 | issue=  | pages= 781857 | pmid=24729754 | doi=10.1155/2014/781857 | pmc=3960550 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24729754  }} </ref><ref name="pmid23233580">{{cite journal| author=Stasi R| title=How to approach thrombocytopenia. | journal=Hematology Am Soc Hematol Educ Program | year= 2012 | volume= 2012 | issue=  | pages= 191-7 | pmid=23233580 | doi=10.1182/asheducation-2012.1.191 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23233580  }} </ref>
** Unexplained bruising ([[Petechia|petechiae]], [[purpura]], [[Bruise|ecchymosis]])
**[[Hepatosplenomegaly]]
**[[Abdominal]] [[tenderness]]
**[[Urinary tract]] (check for [[hematuria]])<ref name="pmid16711312" />
**[[Stool]] for [[occult blood]] (evaluation of [[Gastrointestinal tract|gastrointestinal]] and [[rectal]] bleeding)  
**[[Retinal]] [[hemorrhage]] on [[Fundoscopy|fundoscopic]] exam (evaluation of [[central nervous system]] [[bleeding]])<ref name="pmid16711312">{{cite journal| author=Sekhon SS, Roy V| title=Thrombocytopenia in adults: A practical approach to evaluation and management. | journal=South Med J | year= 2006 | volume= 99 | issue= 5 | pages= 491-8; quiz 499-500, 533 | pmid=16711312 | doi=10.1097/01.smj.0000209275.75045.d4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16711312  }} </ref>
**[[Neurology|Neurologic]] examination (check for [[Intracranial hemorrhage|intracranial bleeding]])<ref name="pmid16711312" />
**[[Soft tissue]] or [[joint]] [[bleeding]] is not associated with [[thrombocytopenia]] and other [[Coagulopathy|coagulation disorders]] such as [[Disseminated intravascular coagulation|DIC]] should be checked.<ref name="pmid23233580" /><ref name="pmid16711312" />

=== Laboratory Findings ===

*[[Complete blood count]] ([[Complete blood count|CBC]])''':''' [[Thrombocytopenia]] in general is defined by platelet count <150 x <math>10^9</math>/L on CBC.<ref name="pmid28030481" />
**The median [[platelet]] count in [[COVID-19]] patients with [[thrombocytopenia]] is 137,500 and 172,000 x <math>10^9</math>/L in severe and non-severe infection, respectively.<ref name="pmid32109013" />

*[[Blood film|Peripheral blood smear]]: [[Peripheral blood smear]] may be helpful if there is suspicion of other disorders that cause [[thrombocytopenia]]. However, there is insufficient evidence recommending routine [[peripheral blood smear]] in [[COVID-19]] patients.
*Other [[laboratory]] testings (such as [[Human Immunodeficiency Virus (HIV)|HIV]], [[Hepatitis C|HCV]] testing, [[antibody]] testing, liver [[enzymes]] and [[Liver function tests|liver function testing]]) are performed if there is suspicion of other disorders that cause [[thrombocytopenia]].

===Electrocardiogram===
* There are no [[The electrocardiogram|ECG]] findings associated with [[COVID-19]]-associated-[[thrombocytopenia]].

===X-ray===
* There are no [[X-rays|x-ray]] findings associated with [[COVID-19]]-associated-[[thrombocytopenia]].

===Echocardiography or Ultrasound===
* There are no [[echocardiography]]/[[ultrasound]] findings associated with [[COVID-19]]-associated-[[thrombocytopenia]].

===CT scan===
* There are no [[Computed tomography|CT]] scan findings associated with [[COVID-19]]-associated-[[thrombocytopenia]].

===MRI===
* There are no [[Magnetic resonance imaging|MRI]] findings associated with [[COVID-19]]-associated-[[thrombocytopenia]].

===Other Imaging Findings===
* There are no other imaging findings associated with [[COVID-19]]-associated-[[thrombocytopenia]].

===Other Diagnostic Studies===

* There are no other diagnostic studies associated with [[COVID-19]]-associated-[[thrombocytopenia]].
* However, [[bone marrow biopsy]] may be helpful if there is suspicion of other disorders that cause [[thrombocytopenia]], but there is insufficient evidence recommending routine [[bone marrow biopsy]] in [[COVID-19]] patients.

==Treatment==
===Medical Therapy===
The treatment options for [[thrombocytopenia]] in [[COVID-19]] infection include:<ref name="pmid32523922">{{cite journal| author=Lorenzo-Villalba N, Zulfiqar AA, Auburtin M, Schuhmacher MH, Meyer A, Maouche Y | display-authors=etal| title=Thrombocytopenia in the Course of COVID-19 Infection. | journal=Eur J Case Rep Intern Med | year= 2020 | volume= 7 | issue= 6 | pages= 001702 | pmid=32523922 | doi=10.12890/2020_001702 | pmc=7279909 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32523922  }} </ref>

*[[Rituximab]]
*[[Thrombopoietin]] receptor [[agonists]] ([[eltrombopag]], [[avatrombopag]], [[romiplostim]])
*High-dose [[dexamethasone]] as an alternative to [[prednisone]]  
*[[Intravenous]] [[immunoglobulins]] ([[IVIG]]) (1 g/kg on 1 or 2 consecutive days or 0.4 g/kg per day for 5 days)
*[[Intravenous]] anti-D (50–75 mg/kg once) (consider potential triggering of [[Disseminated intravascular coagulation|DIC]] or [[hemolysis]])
*[[Platelet]] [[Growth factor|growth factors]] in patients with [[bleeding]], high risk for [[bleeding]], unresponsive to [[prednisone]] (carefully evaluate due to the potential thrombotic events in [[Coronavirus|corona-virus]] infection)
*[[Platelet]] [[transfusion]] in refractory [[visceral]] or [[cerebral]] [[meningeal]] [[hemorrhage]]

===Surgery===
* The mainstay of treatment for severe [[thrombocytopenia]] in [[COVID-19]] infection is medical therapy. 
* Surgery has not been reported to be indicated in [[thrombocytopenia]] in [[COVID-19]] infection.

===Primary Prevention===
* There are no established measures for the [[primary prevention]] of [[thrombocytopenia]] in [[COVID-19]] infection.

===Secondary Prevention===
* There are no established measures for the [[secondary prevention]] of [[thrombocytopenia]] in [[COVID-19]] infection. However, it may include avoidance of [[antiviral]] [[Medication|medications]].

==References==
{{reflist|2}}
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