COVID-19—A Trigger Factor for Severe Immune-Mediated Thrombocytopenia in Active Rheumatoid Arthritis
Thrombocytopenia is defined as a platelet count below 150,000/mm<sup>3</sup> for adults. There is still controversy about whether individuals with platelet counts of 100,000/mm<sup>3</sup> to 150,000/mm<sup>3</sup> should be classified as having genuine thrombocyt...
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MDPI AG
2022-01-01
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| Series: | Life |
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| Online Access: | https://www.mdpi.com/2075-1729/12/1/77 |
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| author | Anca Bobircă Florin Bobircă Ioan Ancuța Anca Florescu Mihai Bojincă Alice Muscă Dan Nicolae Florescu Lucian Mihai Florescu Romina Marina Sima Alesandra Florescu Anca Emanuela Mușetescu |
| author_facet | Anca Bobircă Florin Bobircă Ioan Ancuța Anca Florescu Mihai Bojincă Alice Muscă Dan Nicolae Florescu Lucian Mihai Florescu Romina Marina Sima Alesandra Florescu Anca Emanuela Mușetescu |
| author_sort | Anca Bobircă |
| collection | DOAJ |
| description | Thrombocytopenia is defined as a platelet count below 150,000/mm<sup>3</sup> for adults. There is still controversy about whether individuals with platelet counts of 100,000/mm<sup>3</sup> to 150,000/mm<sup>3</sup> should be classified as having genuine thrombocytopenia or borderline thrombocytopenia. Thrombocytopenia is considered mild when the platelet count is between 70,000 and 150,000/mm<sup>3</sup> and severe if the count is less than 20,000/mm<sup>3</sup>. Thrombocytopenia in rheumatoid arthritis is a rare complication, with an incidence estimated between 3 and 10%. The main etiological aspects include drug-induced thrombocytopenia and immune thrombocytopenic purpura. The most common hematological abnormalities in SARS-CoV-2 infection are lymphopenia and thrombocytopenia. It has been observed that the severity of thrombocytopenia correlates with the severity of the infection, being a poor prognosis indicator and a risk factor for mortality. COVID-19 can stimulate the immune system to destroy platelets by increasing the production of autoantibodies and immune complexes. Autoimmunity induced by viral infections can be related to molecular mimicry, cryptic antigen expression and also spreading of the epitope. During the COVID-19 pandemic, it is of great importance to include the SARS-CoV-2 infection in differential diagnoses, due to the increased variability in forms of presentation of this pathology. In this review, our aim is to present one of the most recently discovered causes of thrombocytopenia, which is the SARS-CoV-2 infection and the therapeutic challenges it poses in association with an autoimmune disease such as rheumatoid arthritis. |
| first_indexed | 2024-03-10T01:07:39Z |
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| institution | Directory Open Access Journal |
| issn | 2075-1729 |
| language | English |
| last_indexed | 2024-03-10T01:07:39Z |
| publishDate | 2022-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Life |
| spelling | doaj.art-aaddc460a8dd42d291879f6690fc9e812023-11-23T14:24:37ZengMDPI AGLife2075-17292022-01-011217710.3390/life12010077COVID-19—A Trigger Factor for Severe Immune-Mediated Thrombocytopenia in Active Rheumatoid ArthritisAnca Bobircă0Florin Bobircă1Ioan Ancuța2Anca Florescu3Mihai Bojincă4Alice Muscă5Dan Nicolae Florescu6Lucian Mihai Florescu7Romina Marina Sima8Alesandra Florescu9Anca Emanuela Mușetescu10Department of Internal Medicine and Rheumatology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, RomaniaDepartment of General Surgery, Carol Davila University of Medicine and Pharmacy, Dr I. Cantacuzino Clinical Hospital, 050474 Bucharest, RomaniaDepartment of Internal Medicine and Rheumatology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, RomaniaDepartment of Internal Medicine and Rheumatology, Dr I. Cantacuzino Clinical Hospital, 011437 Bucharest, RomaniaDepartment of Internal Medicine and Rheumatology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, RomaniaDepartment of Internal Medicine and Rheumatology, Dr I. Cantacuzino Clinical Hospital, 011437 Bucharest, RomaniaDepartment of Gastroenterology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, RomaniaDepartment of Radiology and Medical Imaging, University of Medicine and Pharmacy of Craiova, 200349 Craiova, RomaniaDepartment of Obstetrics and Gynecology, “Bucur” Maternity, “Saint John” Clinical Emergency Hospital, 077160 Bucharest, RomaniaDepartment of Rheumatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, RomaniaDepartment of Rheumatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, RomaniaThrombocytopenia is defined as a platelet count below 150,000/mm<sup>3</sup> for adults. There is still controversy about whether individuals with platelet counts of 100,000/mm<sup>3</sup> to 150,000/mm<sup>3</sup> should be classified as having genuine thrombocytopenia or borderline thrombocytopenia. Thrombocytopenia is considered mild when the platelet count is between 70,000 and 150,000/mm<sup>3</sup> and severe if the count is less than 20,000/mm<sup>3</sup>. Thrombocytopenia in rheumatoid arthritis is a rare complication, with an incidence estimated between 3 and 10%. The main etiological aspects include drug-induced thrombocytopenia and immune thrombocytopenic purpura. The most common hematological abnormalities in SARS-CoV-2 infection are lymphopenia and thrombocytopenia. It has been observed that the severity of thrombocytopenia correlates with the severity of the infection, being a poor prognosis indicator and a risk factor for mortality. COVID-19 can stimulate the immune system to destroy platelets by increasing the production of autoantibodies and immune complexes. Autoimmunity induced by viral infections can be related to molecular mimicry, cryptic antigen expression and also spreading of the epitope. During the COVID-19 pandemic, it is of great importance to include the SARS-CoV-2 infection in differential diagnoses, due to the increased variability in forms of presentation of this pathology. In this review, our aim is to present one of the most recently discovered causes of thrombocytopenia, which is the SARS-CoV-2 infection and the therapeutic challenges it poses in association with an autoimmune disease such as rheumatoid arthritis.https://www.mdpi.com/2075-1729/12/1/77thrombocytopeniaSARS-CoV-2rheumatoid arthritis |
| spellingShingle | Anca Bobircă Florin Bobircă Ioan Ancuța Anca Florescu Mihai Bojincă Alice Muscă Dan Nicolae Florescu Lucian Mihai Florescu Romina Marina Sima Alesandra Florescu Anca Emanuela Mușetescu COVID-19—A Trigger Factor for Severe Immune-Mediated Thrombocytopenia in Active Rheumatoid Arthritis Life thrombocytopenia SARS-CoV-2 rheumatoid arthritis |
| title | COVID-19—A Trigger Factor for Severe Immune-Mediated Thrombocytopenia in Active Rheumatoid Arthritis |
| title_full | COVID-19—A Trigger Factor for Severe Immune-Mediated Thrombocytopenia in Active Rheumatoid Arthritis |
| title_fullStr | COVID-19—A Trigger Factor for Severe Immune-Mediated Thrombocytopenia in Active Rheumatoid Arthritis |
| title_full_unstemmed | COVID-19—A Trigger Factor for Severe Immune-Mediated Thrombocytopenia in Active Rheumatoid Arthritis |
| title_short | COVID-19—A Trigger Factor for Severe Immune-Mediated Thrombocytopenia in Active Rheumatoid Arthritis |
| title_sort | covid 19 a trigger factor for severe immune mediated thrombocytopenia in active rheumatoid arthritis |
| topic | thrombocytopenia SARS-CoV-2 rheumatoid arthritis |
| url | https://www.mdpi.com/2075-1729/12/1/77 |
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