COVID‐19 patient with immune thrombocytopenic purpura

Kewan, Tariq; Almhana, Farah; Schwartzman, L.; Daw, Hamed; Haddad, Abdo

doi:10.1111/ijlh.13303

Cited by 12 publications

(6 citation statements)

References 6 publications

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“…After the search, 32 articles with a total of 56 cases were selected. 1–32 Our own patient was also included in the final analysis, so 57 cases were analyzed.…”

Section: Methodsmentioning

confidence: 99%

Immune thrombocytopenia and COVID-19: Case report and review of literature

Alonso-Beato

Morales‐Ortega

Fernández

et al. 2021

Lupus

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Immune thrombocytopenia, also known as immune thrombocytopenic purpura (ITP), has been reported as an important complication related to COVID-19. We present a 49-year-old male patient with systemic lupus erythematosus with lupus nephritis, antiphospholipid syndrome and history of ITP who developed an ITP flare in the context of COVID-19. He had no bleeding manifestations and had a good response to prednisone treatment. We review the characteristics of the cases reported to date in the literature, with an analysis of 57 patients. Mean age was 56 years (±19.6 SD), and 50.9% were male. This was the first episode of ITP in most of the patients (86.05%), with SARS-CoV-2 acting as the initial trigger. We found that ITP flares may appear in both mild and severe COVID-19 cases. They also appeared at any time during the course of the disease, 48.2% of patients developed it during hospitalization, while it was diagnosed at admission in the rest of the cases. Platelet counts were significantly lower than other ITP series, with a median nadir platelet count of 8 × 109/L (IQR 2–17.75 × 109/L). These patients show a higher bleeding rate (61.4%) compared with other ITP series. They also show a better response to treatment, with good response to the first line therapies in 76.9% of them. The most common first-line treatment was intravenous immunoglobulin (IVIG), used alone or combined with corticosteroids in 40.4% and 32.7% of cases respectively, while 25% of patients received only corticosteroids. Our review suggests that COVID-19-related ITP can be seen even in previously healthy patients. Clinicians must be aware that ITP may appear both in mild and severe COVID-19, at any time during its course. Given that this kind of ITP seems to be associated with a higher bleeding risk, its diagnosis in a clinical scenario such as COVID-19, where anticoagulant therapy is frequently used, may be critical. Treatment with IVIG and/or corticoids is often effective.

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“…After the search, 32 articles with a total of 56 cases were selected. 1–32 Our own patient was also included in the final analysis, so 57 cases were analyzed.…”

Section: Methodsmentioning

confidence: 99%

Immune thrombocytopenia and COVID-19: Case report and review of literature

Alonso-Beato

Morales‐Ortega

Fernández

et al. 2021

Lupus

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“…In the study population, 26 patients had complete response and 8 patients showed only response to treatment according to study definition. A total of 3 individuals expired: one was due to intracranial hemorrhage [11] and others succumbed to severity of COVID-19 illness after showing platelet response to treatment [15,27]. A total of 4 patients (9%) had relapse following treatment response in the followup period [13,14].…”

Section: Treatment and Clinical Outcomesmentioning

confidence: 99%

Immune Thrombocytopenia Secondary to COVID-19: a Systematic Review

Bhattacharjee

Banerjee

2020

SN Compr. Clin. Med.

270

325

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Immune thrombocytopenia, often known as immune thrombocytopenic purpura (ITP), has emerged as an important complication of COVID-19. A systematic review was done to analyze the clinical profile and outcomes in a total of 45 cases of new-onset ITP in COVID-19 patients described in literature until date. A comprehensive approach is essential for diagnosing COVID-19associated ITP after excluding several concomitant factors that can cause thrombocytopenia in COVID-19. Majority of ITP cases (71%) were found to be elderly (> 50 years) and 75% cases had moderate-to-severe COVID-19. Three patients (7%) were in the pediatric age group. Reports of ITP in asymptomatic COVID-19 patients (7%) underscore the need for COVID-19 testing in newly diagnosed patients with ITP irrespective of COVID-19 symptoms amid this pandemic. ITP onset occurred in 20% cases 3 weeks after onset of COVID-19 symptoms, with many reports after clinical recovery. SARS-CoV-2-mediated immune thrombocytopenia can be attributed to the underlying immune dysregulation, susceptibility mutations in SOCS 1, and other mechanisms, including molecular mimicry, cryptic antigen expression, and epitope spreading. No bleeding manifestations were reported in 31% cases at diagnosis. Severe life-threatening bleeding was uncommon. One case of mortality was attributed to intracranial hemorrhage. Secondary Evans syndrome was diagnosed in one case. Good initial response to short course of glucocorticoids and intravenous immunoglobulin has been found with the exception of delayed lag response in one case. Thrombopoietin receptor agonist usage as a second-line agent has been noted in few cases for short duration with no adverse events. In the relatively short follow-up period, four relapses of ITP were found.

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“…Case reports and case series of ITP induced by COVID-19 have been reported in the literature, and multiple treatment protocols have been suggested. [3][4][5] Here, we report the clinical manifestations, mortality rate, and management of all COVID-19 patients admitted to the hospital and diagnosed with secondary ITP.…”

Section: Introductionmentioning

confidence: 99%

Outcomes and management of immune thrombocytopenia secondary to COVID‐19: Cleveland clinic experience

Kewan

Mushtaq

et al. 2021

Transfusion

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Background: Immune thrombocytopenia (ITP) is an acquired disease characterized by thrombocytopenia secondary to autoantibodies against platelets. Here, we report the clinical characteristics of coronavirus disease 2019 (COVID-19)-induced ITP cases.Study Design and Methods: We retrospectively reviewed 3255 COVID-19 patients. COVID-19-induced ITP was diagnosed after excluding possible common causes. Bleeding severity was assessed based on the modified World Health Organization (WHO) bleeding severity score. Results: We identified 11 (0.34%) patients with COVID-19-induced ITP. Of all patients, 63.6% were males and the median age was 63 years. The median time from COVID-19 diagnosis to the onset of ITP was 10 days.Bleeding observed in 63.6% of the patients. Clinically significant bleeding (WHO Grade 3) occurred in single patient who required blood transfusion. Standard treatment with glucocorticoids and intravenous immunoglobulin (IVIG) was effective in achieving excellent response in most cases. Of all patients, complete response and response to treatment were achieved in 45.5% and 27.3% patients, respectively. The median time to ITP recovery was 4 days. Eltrombopag was used in three patients who relapsed. Four patients required mechanical ventilation, and none of them survived secondary to hypoxic respiratory failure. Conclusion: ITP secondary to COVID-19 usually presents after the first week of symptoms beginning. Most of our patients had WHO Grade 1-2 bleeding scores. Standard treatment with glucocorticoids and IVIG is effective in achieving an excellent response. The safety of eltrombopag is not very well established in COVID-19 patients, and additional studies are needed for a better safety profile.

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COVID‐19 patient with immune thrombocytopenic purpura

Cited by 12 publications

References 6 publications

Immune thrombocytopenia and COVID-19: Case report and review of literature

Immune thrombocytopenia and COVID-19: Case report and review of literature

Immune Thrombocytopenia Secondary to COVID-19: a Systematic Review

Outcomes and management of immune thrombocytopenia secondary to COVID‐19: Cleveland clinic experience

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