SARS-CoV-2 infection-induced immune thrombocytopenia in a patient with orthotopic heart transplantation: A case report and literature review

Immune thrombocytopenia (ITP) is an acquired autoimmune disorder characterized by low platelet counts with increased risk of bleeding. In particular, ITP induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been increasingly reported. Since immunosuppressive regimens in organ transplantation are often the primary cause of increased risk of infection, ITP following solid organ transplantation has occasionally been observed. However, SARS-CoV-2 infection-induced ITP in a heart transplant patient has not been reported. We report the first case of ITP after SARS-CoV-2 infection in an orthotopic heart transplant patient who did not respond well to first-line ITP treatment. We also review the previously reported cases of SARS-CoV-2 infection-induced ITP on immunosuppressive therapy.

Learning objective: Post-transplant immune thrombocytopenia (ITP) may have different mechanisms than ordinal ITP; post-transplant ITP may be associated with donor condition such as history of ITP, autoantibodies, and use of immunosuppressants. Our literature review showed that severe acute respiratory syndrome coronavirus 2 infection-induced ITP patients with autoimmune diseases, with malignant hematologic disorders, or after organ transplantation may be refractory to prednisolone and intravenous immunoglobulin and require second-line ITP treatments.