Practical Recommendations for the Management of Patients With Itp During the Covid-19 Pandemic

Abstract

The current COVID-19 pandemic requires revisiting our current approach to major blood disorders, including ITP (Immune Thrombocytopenia), stirring up the production of several disease-specific practical guidelines. This report describes an updated version of consensus-based practical guidelines on the management of ITP, adapted to the Italian health system and social context. It highlights the role of the hematologist in offering guidance for choosing differentiated approaches in relation to specific circumstances and is intended to provide them with a useful tool for sharing the decision-making process with their patients.
 Probably, the greatest risk to avoid for a patient with suspected, ongoing or relapsed ITP - that is not severe enough to place him or her at risk for major bleeding - is to be infected in non-hospital and hospital healthcare settings. This risk must be carefully considered when adapting the diagnostic and therapeutic approach.
 More in detail, the document first addresses the appropriate management for COVID-19 negative patients with newly diagnosed ITP or who experience a relapse of previous ITP, according to first and second-line lines of treatment s and then the management of COVID-19 positive patients according to their severity, from paucisymptomatic to those requiring admission to Intensive Cure Units (ICU). The pros and cons of the different treatments required to correct platelet count are discussed, as are some specific situations, including chronic ITP, splenectomy, thromboembolic complication and anti COVID-19 vaccination.

Severe immune thrombocytopenia (ITP) following SARS-CoV-2 mRNA vaccine in a girl on immunosuppressive treatment and in prolonged stable phase of ITP.

“…7 Most authors believe that ITP is not an absolute contraindication for the COVID-19 vaccination, given a much higher rate of severe ITP linked with the natural infection. 9 The reasons to strongly suggest the vaccination in our patient were the stable ITP phase, the ongoing immunosuppressive treatment, and the family history of severe SARS-CoV-2 infections. In addition, recent data show that post-vaccination ITP is highly responsive to IV-IG treatment; 7,9 it has also been suggested that corticosteroids and IV-IG are the most effective treatment for thrombocytopenia correction in order to control or prevent severe hemorrhages.…”

“…However, these cases' management and outcome are still not well investigated and reported in the medical literature. 2,9 Herein, we report the case of a young woman with a past medical history of ITP who developed a severe ITP recurrence after the second dose of the Pfizer vaccine, administered while in ITP remission and still on treatment with mycophenolate.…”

“…In addition, recent data show that post-vaccination ITP is highly responsive to IV-IG treatment; 7,9 it has also been suggested that corticosteroids and IV-IG are the most effective treatment for thrombocytopenia correction in order to control or prevent severe hemorrhages. 9 Our patient had a benefit from this combined treatment with rapid and complete disappearance of hemorrhagic symptoms and a full recovery of the platelet count.…”

Refractory primary immune thrombocytopenia (ITP): current clinical challenges and therapeutic perspectives

“…In patients with suspected, ongoing, or relapsed ITP — that is not severe enough to cause significant risk of major bleeding — the main risk is to be infected in healthcare settings. This risk must be carefully considered when adapting the diagnostic and therapeutic approach of ITP [ 94 ]. The following recommendations are expert suggestions of the authors.…”

Immune thrombocytopenic purpura cases following COVID-19 vaccination.

“…We have read the article entitled "Practical recommendations for the management of patients with ITP during the COVID-19 pandemic" recently published in your Journal, and we would like to congratulate the authors for their utility in this historic era. 1 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the resulting coronavirus disease 2019 (COVID-19) have affected tens of millions worldwide, with substantial mortality among older adults and important consequences for the global economy. Therefore, the role of vaccination is crucial in the management of the ongoing pandemic.…”