Delayed‐phase thrombocytopenia in patients with coronavirus disease 2019 (COVID‐19)

  1. Wanxin Chen
  2. Ziping Li
  3. Bohan Yang
  4. Ping Wang
  5. Qiong Zhou
  6. Zhiguo Zhang
  7. Jianhua Zhu
  8. Xuexing Chen
  9. Peng Yang
  10. Hao Zhou

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Abstract

Coronavirus disease 2019 (COVID‐19) can affect the haematopoietic system. Thrombocytopenia at admission was prevalent, while late‐phase or delayed‐phase thrombocytopenia (occurred 14 days after symptom onset) is rare. This retrospective, single‐centre study screened 450 COVID‐19 patients and enrolled 271 patients at the Union Hospital, Wuhan, China, from January 25 to March 9, 2020. COVID‐19‐associated delayed‐phase thrombocytopenia occurred in 11·8% of enrolling patients. The delayed‐phase thrombocytopenia in COVID‐19 is prone to develop in elderly patients or patients with low lymphocyte count on admission. The delayed‐phase thrombocytopenia is significantly associated with increased length of hospital stay and higher mortality rate. Delayed‐phase nadir platelet counts demonstrated a significantly negative correlation with B cell percentages. We also provided and described bone marrow aspiration pathology of three patients with delayed‐phase thrombocytopenia, showing impaired maturation of megakaryocytes. We speculated that immune‐mediated platelet destruction might account for the delayed‐phase thrombocytopenia in a group of patients. In addition, clinicians need to pay attention to the delayed‐phase thrombocytopenia especially at 3–4 weeks after symptom onset.

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  1. Version published to 10.1111/bjh.16885
  2. ScreenIT

    SciScore for 10.1101/2020.04.11.20059170: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The study was performed in accordance to the principles of the Declaration of Helsinki and was approved by the Research Ethics Committee of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (No. 2020-0079-1).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableWe collected data on age, gender, respiratory rate, smoking and comorbidities (Hepatitis B, Hepatitis C, HIV, hepatosplenomegaly, hematological system disease, rheumatic immune system disease, cardio cerebrovascular disease, endocrine system disease, respiratory system disease, digestive system disease, nervous system disease and malignant tumor), symptoms from onset to hospital admission (fever, cough, dyspnea, pharyngalgia, diarrhea, anorexia, abdominal pain, palpitation, hypodynamia, paresthesia, myalgia and dizziness), laboratory values on admission (blood routine, blood coagulation function, blood biochemistry, C-reactive protein, inflammatory cytokines and lymphocyte Subsets), treatment (antiviral agents, antibacterial agents, antifungal agents, corticosteroids, inhaled interferon-α, immunoglobulin and oxygen therapy), as well as living status.

    Table 2: Resources

    Antibodies
    SentencesResources
    The IgG antibody were detected with SARS-CoV-2 IgG antibody detection kit (YHLO biotechnology, Shenzhen, China).
    SARS-CoV-2 IgG
    suggested: None
    Software and Algorithms
    SentencesResources
    All statistical analysis was performed using SPSS v.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    This study has several limitations. First, because our analysis was based on a retrospective study with a relatively small sample, which could cause biases and limit the reliability of our results. Second, the laboratory data were not monitored by strictly fixed time interval due to rapidly evolving epidemic. This might lead to omission of data at the changing time point. Third, our hospital-based study no doubt missed patients who were mild cases and who were treated at home, and our study cohort may represent the more severe end of COVID-19. Fourth, multivariate regression analysis is recommended to recognize the risk factors and the individual odds ratio. Further study integrating more clinical characters is needed to draw a more complete conclusion. Fifth, because several patients were still hospitalized and information regarding clinical outcomes was unavailable at the time of this writing, the relationship between these patients’ prognosis and delayed-phase thrombocytopenia remains to be investigated.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2020.04.11.20059170v1 on medRxiv