A Rare Manifestation of COVID-19

Heparin-induced thrombocytopenia
Platelet count throughout hospital admission labelled with relevant interventions. IVIG, intravenous immunoglobulin.

Autoimmune heparin-induced thrombocytopenia

A 65-year-old male presented in a hospital with shortness of breath, nausea and vomiting. These symptoms started 8 days after being tested positive for COVID-19. After initial workup, massive bilateral pulmonary emboli and thrombocytopenia were seen. The patient was then shifted and admitted to another hospital, where he received inferior vena cava filter. He was initially started on argatroban for autoimmune heparin induced thrombocytopenia prophylaxis. While he was admitted in the hospital, on day 6, he was diagnosed with heparin-induced thrombocytopenia in the setting of COVID-19. Nevertheless, this case highlighted the rare occurrence of HIT in a patient without being exposed to heparin, in a COVID-19 setting, which is a novel infectious agent.

COVID-19 is a major crisis, globally, which has infected over 30 million patients in the United States, resulting in over 500,000 mortalities. The infection continues to affect healthcare workers dur to its wide variety of clinical manifestations and impediments. Furthermore, hematological manifestations are major concern other than respiratory symptoms. Other rare condition linked with COVID 19 is heparin-induced thrombocytopenia.

The incidence of heparin-induced thrombocytopenia in patients exposed to heparin is between 0.2% to 5%. Moreover, it is more common in unfractionated heparin exposure compared to low molecular weight heparin.

Although spontaneous HIT is rare, it is characterized by autoimmune HIT, which develops in the absence of heparin exposure. HIT is a life-threatening complication because it is associated with venous thromboemboli, for example pulmonary embolism or deep vein thrombosis. The mortality of HIT is 20% to 30% and complications include deep vein thrombosis, MI, pulmonary embolism, end-organ damage and death.

Diagnosis and Investigations

Since spontaneous HIT is rare, it wasn’t the initial diagnosis. However, since COVID-19 is different and has an unknown sequela of infections, the initial workup revealed multiple pulmonary emboli and thrombocytopenia, which led to HIT antibody screening for further diagnosis.

Two key diagnostic tests were done for the diagnosis confirmation, which were HIT antibody assay and SRA. Both HIT antibody and SRA tests were positive.

The patient was initially started on argatroban, as mentioned earlier, however, he also received IVIG. The treatments were targeted towards autoimmune mediated, spontaneous heparin induced thrombocytopenia.

Eventually, the patient was discharged with a platelet count of 63 k/μL.


Autoimmune heparin-induced thrombocytopenia: a rare manifestation of COVID-19 https://casereports.bmj.com/content/14/5/e243315

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Dr. Aiman Shahab is a dentist with a bachelor’s degree from Dow University of Health Sciences. She is an experienced freelance writer with a demonstrated history of working in the health industry. Skilled in general dentistry, she is currently working as an associate dentist at a private dental clinic in Karachi, freelance content writer and as a part time science instructor with Little Medical School. She has also been an ambassador for PDC in the past from the year 2016 – 2018, and her responsibilities included acting as a representative and volunteer for PDC with an intention to make the dental community of Pakistan more connected and to work for benefiting the underprivileged. When she’s not working, you’ll either find her reading or aimlessly walking around for the sake of exploring. Her future plans include getting a master’s degree in maxillofacial and oral surgery, settled in a metropolitan city of North America.


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