VPB0315 - A rare case of thrombosis with ITP

Sunday, July 10, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: Virtual

Presenting Author(s)

LH

Liana Hambardzumyan

Co-Author(s)

NS

Nelli S. Sargsyan

MD
Armenian Hemophilia and Thrombosis Treatment center
Yerevan, Yerevan, Armenia
GT

Gevorg N. Tamamyan

Head of the Department of Pediatric Oncology and Hematology, Yerevan State Medical University
Armenian Hemophilia and Thrombosis Treatment center
Yerevan, Yerevan, Armenia
AH

Armine Harutyunyan

Gynecologists
Yerevan State Medical University, Depatment of Obstetrics and Gynecology
Yerevan, Yerevan, Armenia
IK

Inga Karapetyan

MD, PhD
Armenian Hemophilia and Thrombosis Treatment center
Yerevan, Yerevan, Armenia
NY

Nune Yeghiazaryan

Neurologist
Erebuni Medical Center, Yerevan, Armenia, Stroke Center
Yerevan, Yerevan, Armenia
LM

Lilit Minasyan

Neurologist
Erebuni Medical Center, Yerevan, Armenia, Stroke Center
Yerevan, Yerevan, Armenia
AV

Astghik Voskanyan

Hematologist-oncologist
Hematology Center after Prof. R.H. Yeolyan, Yerevan, Armenia
Yerevan, Yerevan, Armenia
LH

Liana Hambardzumyan, Phd

MD
Armenian Hemophilia and Thrombosis Treatment center
Yerevan, Yerevan, Armenia

Background: Immune hemolytic anemia (AIHA) and thrombocytopenia (ITP) may rarely coexist with autoimmune disorders. Primary IHA and ITP usually respond to steroids and intravenous immunoglobulins. However, IHA+ITP may be difficult to treat when associated with autoimmune disorders.

Aims: We report a case of a 57-year-old man diagnosed with AIHA and ITP and also found to have thyroiditis.

Methods: A retrospective review of the patient’s medical history was performed.

Results: A 57-year-old-woman with bruises, weakness, fatigue, and dizziness was admitted to the hematology center.
This time CBC test was revealed hyperchromic macrocytic anemia with anisocytosis, thrombocytopenia, lymphocytosis and high level of ESR. Coomb's reactions were positive. The patient had been on autoimmune thyroiditis for about 5 years and was receiving 50 mg of L-thyroxin.
Laboratory testing revealed only slightly elevated LDH level in serum and no other significant abnormalities. Instrumental examination were also normal. Our differential diagnosis included TTP, Evans and marrow infiltrative disorders. Direct antiglobulin test positive (IgG, IgG + C3d).
We made a diagnosis of immune hemolytic anemia and thrombocytopenia and started treatment with Prednisolone 65mg per day.
In about six months Duplex scan showed acute thrombosis of right external iliac vein.
October 2021. The patient was diagnosed with COVID-19, Bilateral interstitial pneumnonia.
On the way home ischemic stroke occurred. Thrombectomy - within 12 hours

Conclusion(s): ITP can rarely coexist with thyroiditis and Thrombosis episode. In such cases, we involuntarily deviate from the contraindications of standard anticoagulant therapy, and, regardless of the low platelet count, administer anticoagulant therapy and combine it with steroid medication. The clinical case is evidence that the treatment of concomitant immune system disorders improves the course of treatment for all pathologies but poses a thrombotic complication.