Immune thrombocytopenia during COVID-19 pandemic: An italian monocentric experience

Background : Since the pandemic caused by severe acute respiratory syndrome coronavirus-2(SARS-CoV2), known as COVID-19, has started in February 2020, different cases of immune thrombocytopenia (ITP) in patients (pts) affected by SARS-CoV2 have been reported. The management of COVID-19 in pts with simultaneous/previous ITP is challenging for the involvement of the haemostatic system. Aims : To describe the management and outcome of pts with ITP and COVID-19. Methods : Data were collected from clinical charts. All pts expressed their agreement. Results : 17 pts had RT-PCR confirmed SARS-CoV2 infection on a nasopharyngeal swab (October 2020-January 2021). Six pts were male (35.3%), 11 female (64.7%);median age 57 years (30-90). At the time of the infection, as regards ITP, pts were grouped as follows: 3 had simultaneous newly-diagnosed (ND) ITP (17.6%) and 1 experienced a relapse (5.8%) [median platelet count 5.5 × 109 /L (2-30 × 109 /L)];7 had chronic ITP on treatment (41.2%) (eltrombopag, n = 5;romiplostim, n = 1;prednisone, n = 1) and 2 had stable chronic ITP off-therapy (11.8%) [(median platelet count 63 × 109 /L (30-100 × 109 /L)];4 pts had a previous ITP (complete responders, CR) on follow-up (23.6%) (platelet count >100 × 109 /L). Only 2 pts had no COVID-related symptoms (11.8%). The most common symptoms were fever, anosmia, articular pain, mild-to-moderate respiratory distress. Three pts required hospitalization for acute platelet decrease and mucocutaneous bleeding (ND-ITP, n = 2;relapse, n = 1) and were responsive to intravenous dexamethasone (40 mg/ day, days 1-4) and immunoglobulins (1 g/kg) (17.6%). Three pts were hospitalized for pneumonia (ND-ITP, n = 1;chronic ITP, n = 1;CR, n = 1) and required antibiotics and oral corticosteroid (17.6%). Eleven pts recovered at home without bleeding;their platelet count did not show any change at the evaluation after quarantine (64.7%). All pts had seroconversion;no death occurred. Conclusions : ND-ITP triggered by COVID-19 is responsive to immunoglobulins and steroids. Outcome is favourable also for COVID-19 pts with off-therapy or on treatment ITP.