PB1401 - Severe Covid-19 Infection in Pregnancy complicated by Heparin Induced Thrombocytopenia

Background: As the pandemic has progressed with emergence of new variants, data on pregnancies with COVID-19 infection has evolved. Pregnant women represent a high-risk population with increasing incidence of maternal morbidity and mortality

Aims: We present a case report of a 31-year-old primipara presenting with severe COVID-19 infection and thrombosis antepartum complicated by the development of heparin induced thrombocytopenia (HIT) post partum.

Methods: A 31 year not previously vaccinated for SARS-CoV-2, presented at 28 weeks gestational age with severe COVID-19 infection requiring Non-invasive respiratory support. A CT pulmonary angiogram revealed COVID pneumonitis with distal pulmonary emboli. Blood tests- platelet count of 280 X 109/L, Prothrombin time (PT) of 12 seconds, Partial thromboplastin time (APTT) of 28 seconds and a derived Fibrinogen of 6.9 g/L. She received Tocilizumab/Sarilumab, steroids and treatment dose of low molecular weight heparin (LMWH). With ongoing concerns of fetal distress and deteriorating maternal condition requiring invasive respiratory support, an emergency Cesarean section (CS) was performed on day 3 of admission. Intravenous heparin infusion was restarted post-operatively and LMWH recommenced on day 1 after the CS. On day 13 post CS HIT screen was requested with positive anti-PF4/heparin antibodies (Acustar®) (optical density 7.2). LMWH was stopped; argatroban initiated due to need for procedures and the platelet count improved. There was no evidence of further extension or recurrence of thrombo embolic disease.

Results: Thrombocytopenia is frequent in critically ill patients. The occurrence of HIT in critically ill COVID-19 patients has been described.

Conclusion(s): Critical illness and complications such as COVID-19 associated coagulopathy and HIT occurring during pregnancy require multidisciplinary plan with close collaboration between various specialties. Adverse outcomes of COVID-19 infection in pregnancy may be uncommon and therefore international collaboration such as ISTH COV-PREG-Coag Registry is critical improve the global understanding of the infection in pregnancy.