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Revision as of 16:13, 25 June 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Synonyms and keywords:

Overview

There is an association between severe COVID-19 infection and thrombocytopenia.^[1]

Historical Perspective

~~[Disease name] was first discovered by [name of scientist], a [nationality + occupation], in [year]/during/following [event].~~

~~The association between [important risk factor/cause] and [disease name] was made in/during [year/event].~~

~~In [year], [scientist] was the first to discover the association between [risk factor] and the development of [disease name].~~

~~In [year], [gene] mutations were first implicated in the pathogenesis of [disease name].~~

~~There have been several outbreaks of [disease name], including -----.~~

~~In [year], [diagnostic test/therapy] was developed by [scientist] to treat/diagnose [disease name].~~

Classification

~~There is no established system for the classification of [disease name].~~

OR

~~[Disease name] may be classified according to [classification method] into [number] subtypes/groups: [group1], [group2], [group3], and [group4].~~

OR

[Disease name] may be classified into [large number > 6] subtypes based on [classification method 1], [classification method 2], and [classification method 3]. [Disease name] may be classified into several subtypes based on [classification method 1], [classification method 2], and [classification method 3].

OR

~~Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.~~

OR

If the staging system involves specific and characteristic findings and features: According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].

OR

~~The staging of [malignancy name] is based on the [staging system].~~

OR

~~There is no established system for the staging of [malignancy name].~~

Pathophysiology

The pathogenesis of thrombocytopenia in COVID-19 infection is due to several factors:^[2]

Decrease in primary platelet production due to infection of bone marrow cells by coronaviruses^[3] and inhibition of bone marrow growth,^[4] which lead to abnormal hematopoietic function.^[2]

Increase in platelet destruction due to increase in auto-antibodies and immune complexes.^[5]

Decrease in circulating platelet due to lung injury which causes megakaryocyte fragmentation and decreases platelet production, because lung is a reservoir for megakaryocyte and hematopoieitic progenitor cells and has a role in platelet production.^[2]^[6]
In addition, decrease in platelets may be due to activation of platelets that result in platelet aggregation and formation of micro-thrombus which increase platelet consumption.^[2]^[7]

Causes

~~Disease name] may be caused by [cause1], [cause2], or [cause3].~~

OR

~~Common causes of [disease] include [cause1], [cause2], and [cause3].~~

OR

~~The most common cause of [disease name] is [cause 1]. Less common causes of [disease name] include [cause 2], [cause 3], and [cause 4].~~

OR

~~The cause of [disease name] has not been identified. To review risk factors for the development of [disease name], click here.~~

Differentiating ((Page name)) from other Diseases

[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].

OR

~~[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].~~

Epidemiology and Demographics

Thrombocytopenia is seen in 57.7% of patients with severe COVID-19 infection compared to 31.6 % of patients with non-severe infection.^[8]

Risk Factors

~~There are no established risk factors for [disease name].~~

OR

~~The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].~~

OR

~~Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].~~

OR

~~Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.~~

Screening

~~There is insufficient evidence to recommend routine screening for [disease/malignancy].~~

OR

~~According to the [guideline name], screening for [disease name] is not recommended.~~

OR

~~According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].~~

Natural History, Complications, and Prognosis

If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

OR

Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].

OR

Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.

Diagnosis

Diagnostic Study of Choice

~~The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].~~

OR

~~The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].~~

OR

~~The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].~~

OR

~~There are no established criteria for the diagnosis of [disease name].~~

History and Symptoms

~~The majority of patients with [disease name] are asymptomatic.~~

OR

The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].

Physical Examination

~~Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].~~

OR

~~Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].~~

OR

~~The presence of [finding(s)] on physical examination is diagnostic of [disease name].~~

OR

~~The presence of [finding(s)] on physical examination is highly suggestive of [disease name].~~

Laboratory Findings

~~An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].~~

OR

~~Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].~~

OR

~~[Test] is usually normal among patients with [disease name].~~

OR

~~Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].~~

OR

~~There are no diagnostic laboratory findings associated with [disease name].~~

Electrocardiogram

~~There are no ECG findings associated with [disease name].~~

OR

~~An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].~~

X-ray

~~There are no x-ray findings associated with [disease name].~~

OR

~~An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].~~

OR

There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

Echocardiography or Ultrasound

~~There are no echocardiography/ultrasound findings associated with [disease name].~~

OR

Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

CT scan

~~There are no CT scan findings associated with [disease name].~~

OR

~~[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].~~

OR

There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

MRI

~~There are no MRI findings associated with [disease name].~~

OR

~~[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].~~

OR

There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

Other Imaging Findings

~~There are no other imaging findings associated with [disease name].~~

OR

~~[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].~~

Other Diagnostic Studies

~~There are no other diagnostic studies associated with [disease name].~~

OR

~~[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].~~

OR

Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].

Treatment

Medical Therapy

There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

Surgery

Surgical intervention is not recommended for the management of [disease name].

OR

Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]

OR

The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].

OR

The feasibility of surgery depends on the stage of [malignancy] at diagnosis.

OR

Surgery is the mainstay of treatment for [disease or malignancy].

Primary Prevention

There are no established measures for the primary prevention of [disease name].

OR

There are no available vaccines against [disease name].

OR

Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

OR

[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].

Secondary Prevention

There are no established measures for the secondary prevention of [disease name].

OR

Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].

References

↑ Lippi G, Plebani M, Henry BM (2020). "Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis". Clin Chim Acta. 506: 145–148. doi:10.1016/j.cca.2020.03.022. PMC 7102663 Check |pmc= value (help). PMID 32178975 Check |pmid= value (help).
↑ ^2.0 ^2.1 ^2.2 ^2.3 Xu P, Zhou Q, Xu J (2020). "Mechanism of thrombocytopenia in COVID-19 patients". Ann Hematol. 99 (6): 1205–1208. doi:10.1007/s00277-020-04019-0. PMC 7156897 Check |pmc= value (help). PMID 32296910 Check |pmid= value (help).
↑ Yang M, Ng MH, Li CK (2005). "Thrombocytopenia in patients with severe acute respiratory syndrome (review)". Hematology. 10 (2): 101–5. doi:10.1080/10245330400026170. PMID 16019455.
↑ Yeager CL, Ashmun RA, Williams RK, Cardellichio CB, Shapiro LH, Look AT; et al. (1992). "Human aminopeptidase N is a receptor for human coronavirus 229E". Nature. 357 (6377): 420–2. doi:10.1038/357420a0. PMC 7095410 Check |pmc= value (help). PMID 1350662.
↑ Nardi M, Tomlinson S, Greco MA, Karpatkin S (2001). "Complement-independent, peroxide-induced antibody lysis of platelets in HIV-1-related immune thrombocytopenia". Cell. 106 (5): 551–61. doi:10.1016/s0092-8674(01)00477-9. PMID 11551503.
↑ Lefrançais E, Ortiz-Muñoz G, Caudrillier A, Mallavia B, Liu F, Sayah DM; et al. (2017). "The lung is a site of platelet biogenesis and a reservoir for haematopoietic progenitors". Nature. 544 (7648): 105–109. doi:10.1038/nature21706. PMC 5663284. PMID 28329764.
↑ Liu X, Zhang R, He G (2020). "Hematological findings in coronavirus disease 2019: indications of progression of disease". Ann Hematol. doi:10.1007/s00277-020-04103-5. PMC 7266734 Check |pmc= value (help). PMID 32495027 Check |pmid= value (help).
↑ Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX; et al. (2020). "Clinical Characteristics of Coronavirus Disease 2019 in China". N Engl J Med. 382 (18): 1708–1720. doi:10.1056/NEJMoa2002032. PMC 7092819 Check |pmc= value (help). PMID 32109013 Check |pmid= value (help).

Template:WikiDoc Sources

[pmid32178975-1] Lippi G, Plebani M, Henry BM (2020). "Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis". Clin Chim Acta. 506: 145–148. doi:10.1016/j.cca.2020.03.022. PMC 7102663 Check |pmc= value (help). PMID 32178975 Check |pmid= value (help).

[pmid32296910-2] 2.0 ^2.1 ^2.2 ^2.3 Xu P, Zhou Q, Xu J (2020). "Mechanism of thrombocytopenia in COVID-19 patients". Ann Hematol. 99 (6): 1205–1208. doi:10.1007/s00277-020-04019-0. PMC 7156897 Check |pmc= value (help). PMID 32296910 Check |pmid= value (help).

[pmid16019455-3] Yang M, Ng MH, Li CK (2005). "Thrombocytopenia in patients with severe acute respiratory syndrome (review)". Hematology. 10 (2): 101–5. doi:10.1080/10245330400026170. PMID 16019455.

[pmid1350662-4] Yeager CL, Ashmun RA, Williams RK, Cardellichio CB, Shapiro LH, Look AT; et al. (1992). "Human aminopeptidase N is a receptor for human coronavirus 229E". Nature. 357 (6377): 420–2. doi:10.1038/357420a0. PMC 7095410 Check |pmc= value (help). PMID 1350662.

[pmid11551503-5] Nardi M, Tomlinson S, Greco MA, Karpatkin S (2001). "Complement-independent, peroxide-induced antibody lysis of platelets in HIV-1-related immune thrombocytopenia". Cell. 106 (5): 551–61. doi:10.1016/s0092-8674(01)00477-9. PMID 11551503.

[pmid28329764-6] Lefrançais E, Ortiz-Muñoz G, Caudrillier A, Mallavia B, Liu F, Sayah DM; et al. (2017). "The lung is a site of platelet biogenesis and a reservoir for haematopoietic progenitors". Nature. 544 (7648): 105–109. doi:10.1038/nature21706. PMC 5663284. PMID 28329764.

[pmid32495027-7] Liu X, Zhang R, He G (2020). "Hematological findings in coronavirus disease 2019: indications of progression of disease". Ann Hematol. doi:10.1007/s00277-020-04103-5. PMC 7266734 Check |pmc= value (help). PMID 32495027 Check |pmid= value (help).

[pmid32109013-8] Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX; et al. (2020). "Clinical Characteristics of Coronavirus Disease 2019 in China". N Engl J Med. 382 (18): 1708–1720. doi:10.1056/NEJMoa2002032. PMC 7092819 Check |pmc= value (help). PMID 32109013 Check |pmid= value (help).

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@@ Line 7: / Line 7: @@
 ==Overview==
+There is an association between severe [[COVID-19]] infection and [[thrombocytopenia]].<ref name="pmid32178975">{{cite journal| author=Lippi G, Plebani M, Henry BM| title=Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis. | journal=Clin Chim Acta | year= 2020 | volume= 506 | issue=  | pages= 145-148 | pmid=32178975 | doi=10.1016/j.cca.2020.03.022 | pmc=7102663 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32178975  }} </ref>
-* There is an association between severe [[COVID-19]] infection and [[thrombocytopenia]].<ref name="pmid32178975">{{cite journal| author=Lippi G, Plebani M, Henry BM| title=Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis. | journal=Clin Chim Acta | year= 2020 | volume= 506 | issue=  | pages= 145-148 | pmid=32178975 | doi=10.1016/j.cca.2020.03.022 | pmc=7102663 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32178975  }} </ref>
-* Thrombocytopenia is seen in 57.7% of patients with severe [[COVID-19]] infection compared to 31.6 % of patients with non-severe infection.<ref name="pmid32109013">{{cite journal| author=Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX | display-authors=etal| title=Clinical Characteristics of Coronavirus Disease 2019 in China. | journal=N Engl J Med | year= 2020 | volume= 382 | issue= 18 | pages= 1708-1720 | pmid=32109013 | doi=10.1056/NEJMoa2002032 | pmc=7092819 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32109013  }} </ref>
-The [[pathogenesis]] of [[thrombocytopenia]] in [[COVID-19]] infection is due to several factors:<ref name="pmid32296910">{{cite journal| author=Xu P, Zhou Q, Xu J| title=Mechanism of thrombocytopenia in COVID-19 patients. | journal=Ann Hematol | year= 2020 | volume= 99 | issue= 6 | pages= 1205-1208 | pmid=32296910 | doi=10.1007/s00277-020-04019-0 | pmc=7156897 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32296910  }} </ref>
-* Decrease in primary platelet production due to infection of bone marrow cells by [[Coronavirus|coronaviruses]]<ref name="pmid16019455">{{cite journal| author=Yang M, Ng MH, Li CK| title=Thrombocytopenia in patients with severe acute respiratory syndrome (review). | journal=Hematology | year= 2005 | volume= 10 | issue= 2 | pages= 101-5 | pmid=16019455 | doi=10.1080/10245330400026170 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16019455  }} </ref> and inhibition of bone marrow growth,<ref name="pmid1350662">{{cite journal| author=Yeager CL, Ashmun RA, Williams RK, Cardellichio CB, Shapiro LH, Look AT | display-authors=etal| title=Human aminopeptidase N is a receptor for human coronavirus 229E. | journal=Nature | year= 1992 | volume= 357 | issue= 6377 | pages= 420-2 | pmid=1350662 | doi=10.1038/357420a0 | pmc=7095410 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1350662  }} </ref> which lead to abnormal [[hematopoietic]] function.<ref name="pmid32296910" />
-* Increase in [[platelet]] destruction due to increase in auto-antibodies and immune complexes.<ref name="pmid11551503">{{cite journal| author=Nardi M, Tomlinson S, Greco MA, Karpatkin S| title=Complement-independent, peroxide-induced antibody lysis of platelets in HIV-1-related immune thrombocytopenia. | journal=Cell | year= 2001 | volume= 106 | issue= 5 | pages= 551-61 | pmid=11551503 | doi=10.1016/s0092-8674(01)00477-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11551503  }} </ref>
-* Decrease in circulating platelet due to lung injury which causes [[megakaryocyte]] fragmentation and decreases platelet production, because lung is a reservoir for [[megakaryocyte]] and hematopoieitic progenitor cells and has a role in platelet production.<ref name="pmid32296910" /><ref name="pmid28329764">{{cite journal| author=Lefrançais E, Ortiz-Muñoz G, Caudrillier A, Mallavia B, Liu F, Sayah DM | display-authors=etal| title=The lung is a site of platelet biogenesis and a reservoir for haematopoietic progenitors. | journal=Nature | year= 2017 | volume= 544 | issue= 7648 | pages= 105-109 | pmid=28329764 | doi=10.1038/nature21706 | pmc=5663284 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28329764  }} </ref>
-*In addition, decrease in [[platelets]] may be due to activation of platelets that result in platelet aggregation and formation of micro-thrombus which increase platelet consumption.<ref name="pmid32296910" /><ref name="pmid32495027">{{cite journal| author=Liu X, Zhang R, He G| title=Hematological findings in coronavirus disease 2019: indications of progression of disease. | journal=Ann Hematol | year= 2020 | volume=  | issue=  | pages=  | pmid=32495027 | doi=10.1007/s00277-020-04103-5 | pmc=7266734 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32495027  }} </ref>
 ==Historical Perspective==
-[Disease name] was first discovered by [name of scientist], a [nationality + occupation], in [year]/during/following [event].
+<s>[Disease name] was first discovered by [name of scientist], a [nationality + occupation], in [year]/during/following [event].</s>
-The association between [important risk factor/cause] and [disease name] was made in/during [year/event].
+<s>The association between [important risk factor/cause] and [disease name] was made in/during [year/event].</s>
-In [year], [scientist] was the first to discover the association between [risk factor] and the development of [disease name].
+<s>In [year], [scientist] was the first to discover the association between [risk factor] and the development of [disease name].</s>
-In [year], [gene] mutations were first implicated in the pathogenesis of [disease name].
+<s>In [year], [gene] mutations were first implicated in the pathogenesis of [disease name].</s>
-There have been several outbreaks of [disease name], including -----.
+<s>There have been several outbreaks of [disease name], including -----.</s>
-In [year], [diagnostic test/therapy] was developed by [scientist] to treat/diagnose [disease name].
+<s>In [year], [diagnostic test/therapy] was developed by [scientist] to treat/diagnose [disease name].</s>
 ==Classification==
-There is no established system for the classification of [disease name].
+<s>There is no established system for the classification of [disease name].</s>
-OR
+<s>OR</s>
-[Disease name] may be classified according to [classification method] into [number] subtypes/groups: [group1], [group2], [group3], and [group4].
+<s>[Disease name] may be classified according to [classification method] into [number] subtypes/groups: [group1], [group2], [group3], and [group4].</s>
-OR
+<s>OR</s>
-[Disease name] may be classified into [large number > 6] subtypes based on [classification method 1], [classification method 2], and [classification method 3].
+<s>[Disease name] may be classified into [large number > 6] subtypes based on [classification method 1], [classification method 2], and [classification method 3].
-[Disease name] may be classified into several subtypes based on [classification method 1], [classification method 2], and [classification method 3].
+[Disease name] may be classified into several subtypes based on [classification method 1], [classification method 2], and [classification method 3].</s>
-OR
+<s>OR</s>
-Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.
+<s>Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.</s>
-OR
+<s>OR</s>
-If the staging system involves specific and characteristic findings and features:
+<s>If the staging system involves specific and characteristic findings and features:
-According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].
+According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].</s>
-OR
+<s>OR</s>
-The staging of [malignancy name] is based on the [staging system].
+<s>The staging of [malignancy name] is based on the [staging system].</s>
-OR
+<s>OR</s>
-There is no established system for the staging of [malignancy name].
+<s>There is no established system for the staging of [malignancy name].</s>
 ==Pathophysiology==
-The exact pathogenesis of [disease name] is not fully understood.
+The [[pathogenesis]] of [[thrombocytopenia]] in [[COVID-19]] infection is due to several factors:<ref name="pmid32296910">{{cite journal| author=Xu P, Zhou Q, Xu J| title=Mechanism of thrombocytopenia in COVID-19 patients. | journal=Ann Hematol | year= 2020 | volume= 99 | issue= 6 | pages= 1205-1208 | pmid=32296910 | doi=10.1007/s00277-020-04019-0 | pmc=7156897 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32296910  }} </ref>
-OR
+* Decrease in primary platelet production due to infection of bone marrow cells by [[Coronavirus|coronaviruses]]<ref name="pmid16019455">{{cite journal| author=Yang M, Ng MH, Li CK| title=Thrombocytopenia in patients with severe acute respiratory syndrome (review). | journal=Hematology | year= 2005 | volume= 10 | issue= 2 | pages= 101-5 | pmid=16019455 | doi=10.1080/10245330400026170 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16019455  }} </ref> and inhibition of bone marrow growth,<ref name="pmid1350662">{{cite journal| author=Yeager CL, Ashmun RA, Williams RK, Cardellichio CB, Shapiro LH, Look AT | display-authors=etal| title=Human aminopeptidase N is a receptor for human coronavirus 229E. | journal=Nature | year= 1992 | volume= 357 | issue= 6377 | pages= 420-2 | pmid=1350662 | doi=10.1038/357420a0 | pmc=7095410 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1350662  }} </ref> which lead to abnormal [[hematopoietic]] function.<ref name="pmid32296910" />
-It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].
+* Increase in [[platelet]] destruction due to increase in auto-antibodies and immune complexes.<ref name="pmid11551503">{{cite journal| author=Nardi M, Tomlinson S, Greco MA, Karpatkin S| title=Complement-independent, peroxide-induced antibody lysis of platelets in HIV-1-related immune thrombocytopenia. | journal=Cell | year= 2001 | volume= 106 | issue= 5 | pages= 551-61 | pmid=11551503 | doi=10.1016/s0092-8674(01)00477-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11551503  }} </ref>
-OR
+* Decrease in circulating platelet due to lung injury which causes [[megakaryocyte]] fragmentation and decreases platelet production, because lung is a reservoir for [[megakaryocyte]] and hematopoieitic progenitor cells and has a role in platelet production.<ref name="pmid32296910" /><ref name="pmid28329764">{{cite journal| author=Lefrançais E, Ortiz-Muñoz G, Caudrillier A, Mallavia B, Liu F, Sayah DM | display-authors=etal| title=The lung is a site of platelet biogenesis and a reservoir for haematopoietic progenitors. | journal=Nature | year= 2017 | volume= 544 | issue= 7648 | pages= 105-109 | pmid=28329764 | doi=10.1038/nature21706 | pmc=5663284 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28329764  }} </ref>
+*In addition, decrease in [[platelets]] may be due to activation of platelets that result in platelet aggregation and formation of micro-thrombus which increase platelet consumption.<ref name="pmid32296910" /><ref name="pmid32495027">{{cite journal| author=Liu X, Zhang R, He G| title=Hematological findings in coronavirus disease 2019: indications of progression of disease. | journal=Ann Hematol | year= 2020 | volume=  | issue=  | pages=  | pmid=32495027 | doi=10.1007/s00277-020-04103-5 | pmc=7266734 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32495027  }} </ref>
-[Pathogen name] is usually transmitted via the [transmission route] route to the human host.
-OR
-Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
-OR
-[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
-OR
-The progression to [disease name] usually involves the [molecular pathway].
-OR
-The pathophysiology of [disease/malignancy] depends on the histological subtype.
 ==Causes==
-Disease name] may be caused by [cause1], [cause2], or [cause3].
+<s>Disease name] may be caused by [cause1], [cause2], or [cause3].</s>
-OR
+<s>OR</s>
-Common causes of [disease] include [cause1], [cause2], and [cause3].
+<s>Common causes of [disease] include [cause1], [cause2], and [cause3].</s>
-OR
+<s>OR</s>
-The most common cause of [disease name] is [cause 1]. Less common causes of [disease name] include [cause 2], [cause 3], and [cause 4].
+<s>The most common cause of [disease name] is [cause 1]. Less common causes of [disease name] include [cause 2], [cause 3], and [cause 4].</s>
-OR
+<s>OR</s>
-The cause of [disease name] has not been identified. To review risk factors for the development of [disease name], click [[Pericarditis causes#Overview|here]].
+<s>The cause of [disease name] has not been identified. To review risk factors for the development of [disease name], click [[Pericarditis causes#Overview|here]].</s>
 ==Differentiating ((Page name)) from other Diseases==
-[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
+<s>[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].</s>
-OR
+<s>OR</s>
-[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
+<s>[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].</s>
 ==Epidemiology and Demographics==
-The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide.
+Thrombocytopenia is seen in 57.7% of patients with severe [[COVID-19]] infection compared to 31.6 % of patients with non-severe infection.<ref name="pmid32109013">{{cite journal| author=Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX | display-authors=etal| title=Clinical Characteristics of Coronavirus Disease 2019 in China. | journal=N Engl J Med | year= 2020 | volume= 382 | issue= 18 | pages= 1708-1720 | pmid=32109013 | doi=10.1056/NEJMoa2002032 | pmc=7092819 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32109013  }} </ref>
-OR
-In [year], the incidence/prevalence of [disease name] was estimated to be [number range] cases per 100,000 individuals worldwide.
-OR
-In [year], the incidence of [disease name] is approximately [number range] per 100,000 individuals with a case-fatality rate of [number range]%.
-Patients of all age groups may develop [disease name].
-OR
-The incidence of [disease name] increases with age; the median age at diagnosis is [#] years.
-OR
-[Disease name] commonly affects individuals younger than/older than [number of years] years of age.
-OR
-[Chronic disease name] is usually first diagnosed among [age group].
-OR
-[Acute disease name] commonly affects [age group].
-There is no racial predilection to [disease name].
-OR
-[Disease name] usually affects individuals of the [race 1] race. [Race 2] individuals are less likely to develop [disease name].
-[Disease name] affects men and women equally.
-OR
-[Gender 1] are more commonly affected by [disease name] than [gender 2]. The [gender 1] to [gender 2] ratio is approximately [number > 1] to 1.
-The majority of [disease name] cases are reported in [geographical region].
-OR
-[Disease name] is a common/rare disease that tends to affect [patient population 1] and [patient population 2].
 ==Risk Factors==
-There are no established risk factors for [disease name].
+<s>There are no established risk factors for [disease name].</s>
-OR
+<s>OR</s>
-The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].
+<s>The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].</s>
-OR
+<s>OR</s>
-Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
+<s>Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].</s>
-OR
+<s>OR</s>
-Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.
+<s>Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.</s>
 ==Screening==
-There is insufficient evidence to recommend routine screening for [disease/malignancy].
+<s>There is insufficient evidence to recommend routine screening for [disease/malignancy].</s>
-OR
+<s>OR</s>
-According to the [guideline name], screening for [disease name] is not recommended.
+<s>According to the [guideline name], screening for [disease name] is not recommended.</s>
-OR
+<s>OR</s>
-According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].
+<s>According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].</s>
 ==Natural History, Complications, and Prognosis==
@@ Line 205: / Line 124: @@
 ==Diagnosis==
-===Diagnostic Study of Choice===
+===<s>Diagnostic Study of Choice</s>===
-The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
+<s>The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].</s>
-OR
+<s>OR</s>
-The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
+<s>The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].</s>
-OR
+<s>OR</s>
-The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
+<s>The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].</s>
-OR
+<s>OR</s>
-There are no established criteria for the diagnosis of [disease name].
+<s>There are no established criteria for the diagnosis of [disease name].</s>
-===History and Symptoms===
+===<s>History and Symptoms</s>===
-The majority of patients with [disease name] are asymptomatic.
+<s>The majority of patients with [disease name] are asymptomatic.</s>
-OR
+<s>OR</s>
-The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
+<s>The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].</s>
 ===Physical Examination===
-Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
+<s>Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].</s>
-OR
+<s>OR</s>
-Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
+<s>Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].</s>
-OR
+<s>OR</s>
-The presence of [finding(s)] on physical examination is diagnostic of [disease name].
+<s>The presence of [finding(s)] on physical examination is diagnostic of [disease name].</s>
-OR
+<s>OR</s>
-The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
+<s>The presence of [finding(s)] on physical examination is highly suggestive of [disease name].</s>
-===Laboratory Findings===
+===<s>Laboratory Findings</s>===
-An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].
+<s>An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].</s>
-OR
+<s>OR</s>
-Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
+<s>Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].</s>
-OR
+<s>OR</s>
-[Test] is usually normal among patients with [disease name].
+<s>[Test] is usually normal among patients with [disease name].</s>
-OR
+<s>OR</s>
-Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
+<s>Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].</s>
-OR
+<s>OR</s>
-There are no diagnostic laboratory findings associated with [disease name].
+<s>There are no diagnostic laboratory findings associated with [disease name].</s>
-===Electrocardiogram===
+===<s>Electrocardiogram</s>===
-There are no ECG findings associated with [disease name].
+<s>There are no ECG findings associated with [disease name].</s>
-OR
+<s>OR</s>
-An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
+<s>An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].</s>
-===X-ray===
+===<s>X-ray</s>===
-There are no x-ray findings associated with [disease name].
+<s>There are no x-ray findings associated with [disease name].</s>
-OR
+<s>OR</s>
-An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
+<s>An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].</s>
-OR
+<s>OR</s>
-There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
+<s>There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].</s>
-===Echocardiography or Ultrasound===
+===<s>Echocardiography or Ultrasound</s>===
-There are no echocardiography/ultrasound  findings associated with [disease name].
+<s>There are no echocardiography/ultrasound  findings associated with [disease name].</s>
-OR
+<s>OR</s>
-Echocardiography/ultrasound  may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
+<s>Echocardiography/ultrasound  may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].</s>
-OR
+<s>OR</s>
-There are no echocardiography/ultrasound  findings associated with [disease name]. However, an echocardiography/ultrasound  may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
+<s>There are no echocardiography/ultrasound  findings associated with [disease name]. However, an echocardiography/ultrasound  may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].</s>
-===CT scan===
+===<s>CT scan</s>===
-There are no CT scan findings associated with [disease name].
+<s>There are no CT scan findings associated with [disease name].</s>
-OR
+<s>OR</s>
-[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
+<s>[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].</s>
-OR
+<s>OR</s>
-There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
+<s>There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].</s>
-===MRI===
+===<s>MRI</s>===
-There are no MRI findings associated with [disease name].
+<s>There are no MRI findings associated with [disease name].</s>
-OR
+<s>OR</s>
-[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
+<s>[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].</s>
-OR
+<s>OR</s>
-There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
+<s>There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].</s>
-===Other Imaging Findings===
+===<s>Other Imaging Findings</s>===
-There are no other imaging findings associated with [disease name].
+<s>There are no other imaging findings associated with [disease name].</s>
-OR
+<s>OR</s>
-[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
+<s>[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].</s>
-===Other Diagnostic Studies===
+===<s>Other Diagnostic Studies</s>===
-There are no other diagnostic studies associated with [disease name].
+<s>There are no other diagnostic studies associated with [disease name].</s>
-OR
+<s>OR</s>
-[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
+<s>[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].</s>
-OR
+<s>OR</s>
-Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].
+<s>Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].</s>
 ==Treatment==