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

Background: Immune thrombocytopenia (ITP) is an acquired immune disorder characterised by a platelet count 100x109/L). Fever, anosmia, dysgeusia, articular pain and mild-to-moderate respiratory distress were considered typically COVID19-related symptoms. Overall, 15 patients were symptomatic: 11 had only COVID19- related symptoms (64.8%), 1 presented with isolated mucocutaneous bleeding (5.8%) and 3 reported both (17.6%). Two patients did not refer any symptoms throughout the course of the infection (11.8%). Six cases required hospitalization (35.3%): 3 for acute decrease of platelet count and bleeding symptoms (17.6%) (ND ITP=2;ITP relapse=1);3 for pneumonia (17.6%) (ND ITP=1;chronic ITP on treatment=1;ITP on FU=1). Patients with bleeding symptoms were responsive to dexamethasone (40 mg/day, days 1-4) and immunoglobulins (1 g/kg). Patients with pneumonia were successfully treated with antibiotics and oral corticosteroids. The median duration of stay in the hospital was 10.5 days (range 3-20). Eleven patients recovered at home without any bleeding;they did not show any significant change in the platelet count at the first evaluation after quarantine (64.7%). Twelve patients had previously received either steroids (n=8) or steroid+splenectomy (n=4) (70.5%). Serious respiratory distress, requiring mechanic ventilation, was not recorded. Anti-thrombotic prophylaxis of COVID-related thromboembolism was not used and no cases of thrombosis were observed. The viral seroconversion was observed in all patients and no death occurred. Summary/Conclusion: In our experience, ND ITP triggered by COVID- 19 has been responsive to immunoglobulins and steroids. Overall outcome has been favourable also for COVID-19 patients with a stable off-therapy or on treatment ITP.