COVID-19 associated with immune thrombocytopenia: a systematic review and meta-analysis

Abstract

Background Immune thrombocytopenia, also known as immune thrombocytopenic purpura (ITP), has emerged as a significant COVID-19-associated complication. This study analyzes the published literature of case reports and case series regarding COVID-19 infection associated with ITP. Methodology In this systematic review and meta-analysis, a systematic search was conducted through PubMed, Web of Science, and Medline through Clarivate and EBSCO to include the eligible studies. The authors utilized Review Manager 5.4 to conduct quantitative data synthesis for the condition of interest analysis. Results A total of 13 eligible case reports and case series with 42 patients were included in this study; 54.8% of them were male. The pooled mean age of all participants was (59.5 ± 19) years with a median age of 63 years. The estimated mean time from diagnosis with COVID-19 to ITP development was 18.1 ± 21 days and the mean time to recovery from ITP was 5.8 ± 4.8 days. The pooled random effect of mean platelet count in the included six studies was 14.52, CI [8.79, 20.25]. Conclusion Our analysis shows that ITP secondary to COVID-19 infection is slightly more prevalent among males (54.8%). Elderly patients were more vulnerable to the disease. Most cases developed ITP within 2–3 weeks after COVID-19 infection and recovered in less than one week from ITP.

Complex changes in serum protein levels in COVID-19 convalescents

“…While low platelet counts can occur any time during the acute phase of COVID-19, it has been frequently observed after clinical recovery 50 , e.g. after three 51,52 or five weeks 53 after onset of symptoms, consistent with our findings. Further, we found significantly reduced levels of proteins of the actin cytoskeleton network amongst recuperated COVID-19 cases, e.g.…”

COVID-19-induced immune thrombocytopenic purpura; Immunopathogenesis and clinical implications

“…They also reported that none of the deaths in patients with COVID-19-induced ITP were associated with bleeding or ITP [14]. In addition, a recent systematic review and meta-analysis reported that most of the patients that had developed COVID-19-associated ITP recovered in less than one week [4]. Alonso-Beato et al reported an overall mortality of 7% in patients with COVID-19-induced ITP.…”

“…A recent systematic review and meta-analysis reported that most of the patients that had developed COVID-19-associated ITP were male (54.8%) and over 50 years of age (median age of 63 years). In addition, most of the patients had developed ITP within 2-3 weeks after SARS-CoV-2 infection and recovered within a week [4].…”

“…On the other hand, changes in laboratory parameters such as elevated liver enzymes, increased creatinine, electrolyte imbalance, a significant increase in C-reactive protein (CRP), and hyper-inflammation are very common in SARS-CoV-2 infection [2]. Various hematological disorders including thrombotic events, lymphopenia, thrombocytopenia, immune thrombocytopenia [or immune thrombocytopenic purpura (ITP)] have been reported in SARS-CoV-2 infection [3,4]. ITP is defined as a platelet count of less than 100,000 per microliter with no evidence of leukopenia or anemia [5].…”

“…It is more prevalent in individuals older than 50 years. Most cases of COVID-19-induced ITP have occurred within 2-3 weeks of SARS-CoV-2 infection and had recovered in less than one week [4]. The patients have shown a good response to treatment, especially with intravenous immunoglobulin (IVIG) and/or corticosteroids [12,14].…”