Practical guidance for the management of adults with immune thrombocytopenia during the COVID‐19 pandemic

Pavord, Sue; Jecko, Thachil; Hunt, Beverley J.; Murphy, Mike; Lowe, Gillian; Laffan, Michael; Makris, Mike; Newland, Adrian C.; Provan, Drew; Grainger, John D.; Hill, Quentin A.

doi:10.1111/bjh.16775

Cited by 93 publications

(131 citation statements)

References 41 publications

(61 reference statements)

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“…According to the UK practical guidance for the management of adults with immune thrombocytopaenia during the COVID-19 pandemic, there is little evidence to inform the optimal management of a patient presenting with new or relapsed acute ITP. 3 In our case of newly diagnosed ITP and concomitant infection by SARS-CoV-2, the treatment dilemma was pronounced. The prothrombotic risk of COVID-19 needed to be balanced between the prohaemorrhagic risk from ITP.…”

Section: Discussionmentioning

confidence: 68%

“…There is an even greater paucity of evidence regarding their effectiveness in these cases. 3 Regarding the TPO-RAs, eltrombopag and romiplostim, there is concern in terms of their prothrombotic potential. In a systematic review of trials for TPO-RAs versus controls, the former were found to have higher rates of thromboembolic events.…”

Section: Discussionmentioning

confidence: 99%

“…As of yet, there have been very limited documented reports of ITP secondary to COVID-19 infection. 3 Furthermore, the vast majority of severe thrombocytopaenia cases involved patients with severe presentations of COVID-19. 4 5 However, this case involved a patient with only mild–moderate symptoms of COVID-19 and no known prior haematological history that manifested as a subacute frontoparietal haematoma and rectal bleed.…”

Section: Introductionmentioning

confidence: 99%

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Severe thrombocytopaenia secondary to COVID-19

et al. 2020

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The SARS-CoV-2 infection has caused a pandemic with a case rate of over 290 000 lab-confirmed cases and over 40 000 deaths in the UK. There is little evidence to inform the optimal management of a patient presenting with new or relapsed acute idiopathic thrombocytopaenic purpura with concurrent SARS-CoV-2 infection. We present a case of severe thrombocytopaenia complicated by subdural haematoma and rectal bleed associated with COVID-19. A 67-year-old man, admitted with a non-productive cough and confusion, was found to be positive for COVID-19. Ten days after admission, his platelets decreased from 146×109/L to 2×109/L. His platelets did not increase despite receiving frequent platelet transfusions. He was non-responsive to corticosteroids and intravenous immunoglobulins. Romiplostim and eltrombopag were given and after 9 weeks of treatment, his platelet count normalised. He was deemed medically fit with outpatient follow-up in a haematology clinic.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Severe thrombocytopaenia secondary to COVID-19

et al. 2020

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“…Dexamethasone may be preferred over prednisolone due to finding of increased response rate at 7 days from trials on adults with ITP [35]. However, duration of GC use should be kept at minimum due to concerns for delayed recovery of active COVID-19 disease [1,53]. It is reassuring to note that low-dose dexamethasone for maximum 10 days can significantly decrease 28-day mortality significantly for COVID-19 patients requiring oxygen or ventilation support [63].…”

Section: Management and Outcomesmentioning

confidence: 99%

Immune Thrombocytopenia Secondary to COVID-19: a Systematic Review

Bhattacharjee

Banerjee

2020

SN Compr. Clin. Med.

245

299

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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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“…However, several viral infections have been associated with ITP in the past [3]. In COVID-19, disruption of the immune response is thought to play an important role in the disease, although the pathophysiology is yet to be better understood [10]. A better understanding of such immune pathway will be essential to de ne best therapeutic approaches to ITP, either associated or not with COVID-19, in the context of the pandemic [10].…”

Section: Discussionmentioning

confidence: 99%

Severe immune thrombocytopenic purpura in critical COVID-19: a case report

Lévesque¹,

Milaire²,

Corsilli³

et al. 2020

Preprint

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Purpose: COVID-19 is a new disease with many undescribed clinical manifestations. Material and methods: We report herein a case of severe immune thrombocytopenic purpura (ITP) in a critical COVID-19 patient.Results: A patient presented a severe episode of immune thrombocytopenia (< 10 x 109/L) 20 days after admission for a critical COVID-19. This thrombocytopenia was associated with a life-threatening bleeding. Response to first-line therapies was delayed as it took up to 13 days after initiation of intravenous immunoglobulin and high dose dexamethasone to observe an increase in platelet count. Conclusion: COVID-19 may be associated with late presenting severe ITP. Such ITP may also be relatively resistant to first-line agents. Hematological manifestations of COVID-19, such as the ones associated with life-threatening bleeding, must be recognized.

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Practical guidance for the management of adults with immune thrombocytopenia during the COVID‐19 pandemic

Cited by 93 publications

References 41 publications

Severe thrombocytopaenia secondary to COVID-19

Severe thrombocytopaenia secondary to COVID-19

Immune Thrombocytopenia Secondary to COVID-19: a Systematic Review

Severe immune thrombocytopenic purpura in critical COVID-19: a case report

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