Impact of COVID-19 Infection, Vaccination, and Serological Response in Immune Thrombocytopenic Purpura Patients: A Single-Center Global Analysis

Abstract

Both SARS-CoV-2 infection and vaccination have raised concern in immune-mediated diseases, including immune thrombocytopenic purpura (ITP) considering risk of de novo ITP development and ITP recurrence. Here, we report on data from a single-center retrospective–prospective collection aiming to evaluate platelet (plt) dynamics in patients (pts) with chronic ITP after COVID-19 infection (before and after vaccination) and after the first, second and third vaccine doses. Furthermore, we analyzed the serological response after the first two doses of COVID-19 vaccination. A total of 64 pts currently followed for chronic ITP who experienced COVD-19 infection and/or vaccination with an available plt count before and after such events were included in the analysis. A low incidence of ITP exacerbation following vaccine sessions (6–16%) was observed in comparison with a high frequency of exacerbation and rescue treatment necessity after COVID-19 infection in unvaccinated pts (83%). Moreover, the lower ITP exacerbation rate observed in infected pts previously vaccinated (18%) suggests further protective effects in this population. Finally, a high seroconversion rate was observed, confirming data reported in previously published studies on immune cytopenia and rheumatological diseases, but more evidence is awaited to establish the clinical impact of serological response.

Characteristics and outcomes of COVID‐19 in Chinese immune thrombocytopenia patients: A prospective cohort study

“…Notably, approximately 1/3 of ITP patients experienced varying degrees of thrombocytopenia after being vaccinated, and only approximately 1/5 of these people's PLT counts recovered to the level before vaccination, with a median recovery time of 3 months. In other research, unvaccinated patients had a high proportion of ITP exacerbation after COVID‐19 35 . However, we found that patients with or without vaccination had no difference in the PLT count after infection.…”

“…In other research, unvaccinated patients had a high proportion of ITP exacerbation after COVID-19. 35 However, we found that patients with or without vaccination had no difference in the PLT count after infection. Then, we studied pre-existing ITP patients with stable and decreased PLT counts after vaccination.…”

Protective effects of COVID‐19 vaccination in splenectomized patients with immune thrombocytopenia

“…Few studies have reported the effect of COVID‐19 infection in patients with chronic ITP, and very few studies have focused on the effect of COVID‐19 vaccination in splenectomized patients with ITP. A previous study reported that patients with ITP who received the COVID‐19 vaccine experienced a lower risk of ITP exacerbation and required less rescue medication when infected with COVID‐19 compared with non‐vaccinated patients (83.0% vs. 18.2%, n = 47) 10 . Our results showed that the protective effect of COVID‐19 vaccination was not lost among splenectomized patients with ITP.…”

“…A previous study reported that patients with ITP who received the COVID-19 vaccine experienced a lower risk of ITP exacerbation and required less rescue medication when infected with COVID-19 compared with non-vaccinated patients (83.0% vs. 18.2%, n = 47). 10 Our results showed that the protective effect of COVID-19 vaccination was not lost among splenectomized patients with ITP. Vaccination not only reduced the risk of severe infection (44.1% vs. 11.5%) and hospitalization (35.7% vs. 5.8%) but also lowered the rate of ITP exacerbation (35.7% vs. 5%) during COVID-19 infection in splenectomized patients with ITP.…”

“…Currently, whether the beneficial effects or the side effects of COVID‐19 vaccination have a greater proportion on these patients remains unclear. Only one study demonstrated a lower rate of ITP exacerbation (6%–16% vs. 83%) in vaccinated patients with ITP than in non‐vaccinated patients during COVID‐19 infection ( n = 64) 10 . Thus, the effects of COVID‐19 vaccination on patients with ITP need to be further explored.…”