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COVID-19 presenting as thrombotic thrombocytopenic purpura (TTP)
  1. Essam Altowyan,
  2. Omar Alnujeidi,
  3. Atheer Alhujilan and
  4. Mohammed Alkathlan
  1. Hematolgy Unit, Department of Medicine, King Fahad Specialist Hospital, Qassim, Saudi Arabia
  1. Correspondence to Dr Essam Altowyan; tessam{at}


We present the case of a 39-year-old man with epigastric pain, nausea and vomiting. The patient scored 4 in the Visual Triage Checklist of acute respiratory symptoms; a COVID-19 swab was taken. Prompt review of the peripheral blood smear showed evidence of microangiopathic haemolytic anaemia and thrombocytopenia. Because the patient had a picture of thrombotic thrombocytopenic purpura, plasma exchange and corticosteroids were started immediately. After 3 days, he developed severe ischaemic stroke and his swabs came back positive for COVID-19 by reverse transcription PCR. Therefore, triple therapy was started (lopinavir/ritonavir, ribavirin and interferon beta-1b). White blood cell count reached 50×109/L (normal range, 4.5–11×109/L), mainly neutrophils. All the workup for autoimmune diseases was negative. The patient showed delayed improvement in lactate dehydrogenase, haemoglobin and platelet count until we increased the volume of plasma exchange and subsided the inflammatory response of COVID-19. After that, the patient showed an excellent recovery.

  • haematology (incl blood transfusion)
  • malignant and benign haematology
  • thrombotic thrombocytopenic purpura
  • stroke
  • influenza

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  • Contributors Both EA and OA are haematology consultant, and they treated the case mentioned in this report and provided all details required. MA took responsibility of COVID-19 treatment as he is an infectious disease consultant. EA and AA took the lead in writing the manuscript. All authors provided critical feedback and helped shape the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.