Transient severe thrombocytopenia with SARS-Cov-2 (COVID-19) infection in pregnancy

A 24-weeks pregnant woman in her 2nd pregnancy presented with mild COVID symptoms and new onset rapidly progressive severe thrombocytopenia with a nadir of 20×109/L. She did not have any bleeding manifestations and the platelet counts recovered over 3 days without the need of steroids or immunoglobulin treatment. COVID-19 infection may cause transient severe thrombocytopenia, and this has not been previously reported in second trimester of pregnancy. We speculate the cause to be immune mediated. Other causes for severe thrombocytopenia were excluded after comprehensive investigations. This raise concerns on thromboprophylaxis and anticoagulant use in early pregnancies infected with COVID-19. Assessing the platelet counts at least two occasions few days apart of an infected patient may be a safer approach if continuing anticoagulants.