COVID-19 complicated by immune thrombocytopaenic purpura and
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COVID-19 has caused a public health emergency of international concern, with millions of infections and deaths worldwide. COVID-19 has been shown to have many effects on multiple bodily systems; this includes haematological and thrombotic manifestations.

Immune thrombocytopenia purpura (ITP) is characterised by an immune-mediated reaction resulting in a significant reduction in platelet counts. Mild thrombocytopenia has been frequently reported in patients with COVID-19; however, more severe thrombocytopenia has rarely been seen.

This patient was found to have bilateral deep vein thrombosis (DVTs) in the internal jugular veins likely secondary to COVID-19, ITP or both. A focus of this case is to increase awareness of haematological complications of COVID-19 infection including ITP and thromboembolism. As the rates of COVID-19 continue to increase, complications of COVID-19 are likely to continue to emerge.

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.

Learning points:
To be vigilant for COVID-19 complications regardless of the severity of symptoms.

A systematic approach is essential to diagnose new-onset immune thrombocytopenia purpura (ITP) after excluding several concomitant factors or conditions that can cause thrombocytopenia in COVID-19.

Treatment with intravenous immunoglobulin for ITP in the context of COVID-19 appears to be effective.

Both COVID-19 and ITP are associated with increased risk of thromboembolism.

In the management of ITP, platelet transfusions are only given in cases where bleeding is thought to be life threatening or in a potentially fatal site, such as intracranial.

Frequency of doing a routine blood test for patients with COVID-19 with mild to moderate symptoms needs to be reviewed to assist with early identification of COVID-19 potential complications, such as ITP.