Hemorrhagic Problem Among the Patients With COVID-19: Clinical Summary of 41 Thai Infected Patients

In late December 2019, a new emerging infectious disease, coronavirus disease 2019 (COVID-19), started in China.¹ The disease already spread to more than 40 countries at present (February 29, 2020). Thailand is the second country that was affected by this new disease.² Focusing on clinical presentation of this new coronavirus infection, the main clinical presentation is acute febrile illness with pulmonary complications.

In clinical hematology, the effect of the infection is reported. Leukopenia is a common clinical blood picture.^3,4 Regarding the alteration of coagulation system, decreased platelet count and prothrombin time is observable.^3,4 In fact, this is similar observation to that seen in a previous emerging coronavirus infection, Middle East respiratory syndrome.⁵ Nevertheless, there is still no report regarding hemorrhagic problem in the patients with COVID-19. Here, the authors would like to present observation from Thailand on 41 patients (4 males and 37 females, age between 7 and 74 years) with COVID-19 in Thailand (based on most update data at February 29, 2020). The diagnosis of COVID-19 was done by real-time polymerase chain reaction molecular diagnosis and reconfirmed for positive by 2 referencing molecular diagnosis laboratory. All presented with febrile illness and pneumonia within 14 days after history of exposure and the direct human to human contact is mode of transmission. Of these patients, there is no death case (at present, 28 are discharged after complete recovery from illness and 13 are still hospitalized). All of these patients received standard respiratory care in isolate clinical pulmonary unit. Of interest, there is a patient (2.44%) with bleeding presentation, petechiae. For this case, there is no specific additional treatment for hemorrhagic problem. This patient was firstly missed diagnosed to be dengue and cause local transmission to a medical worker.⁶ It is recommended that the practitioner should recognize that hemorrhagic problem might be an initial presentation of COVID-19. Also, investigation and follow-up for possible hemorrhagic problem in patient with COVID-19 is recommended.