Transient increase in platelet counts associated with COVID‐19 infection during TPO‐RA as the second‐line treatment in children with ITP

Abstract

SummaryThe thrombopoietin receptor agonists (TPO‐RA) were recommended for primary immune thrombocytopenia (ITP) during the pandemic of COVID‐19. However, the incidence of thrombocytosis and thrombosis was sporadically reported in the chronic immune thrombocytopenia (CITP) patients receiving TPO‐RA during the COVID‐19 infection. With the local prevalence of COVID‐19 in December 2022 in the Beijing area, we got more powerful evidence about the change in platelet (Plt) counts associated with COVID‐19 infection. A single‐centre observational cohort study was performed from the beginning of December 2022 to the end of February 2023 to enrol CITP children treated with TPO‐RA alone as the second‐line treatment and suffering from the COVID‐19 infection in December 2022. The Plt counts before, during and after COVID‐19 infection were collected. In total, 67 (34 males and 33 females) patients with 8.10 (2.15, 15.70) years of age were enrolled. Sixty‐three patients who had responded to the TPO‐RA showed a transient increase in Plt counts after the infection of COVID‐19. The time of starting to increase was on Day 3 (2, 7), and to the peak level on Day 14 (7, 19) of infection with the peak Plt count was 289 (88, 1974) × 109/L. With at least 2 months observation period from COVID‐19 infection, the Plt counts of 100% (63/63) patients declined to the baseline on Day 25 (14, 41). The phenomenon of transient increase in Plt counts has been shown in the CITP children who responded to TPO‐RA when suffering from COVID‐19 infection.

Can COVID-19 Increase Platelet in Adult Immune Thrombocytopenia During the TPO-RA Administration? A Real-World Observational Study

“…This is consistent with two previous small-sample cases studies, 10,11 and a study of pediatric ITP patients that reported a transient increase in platelet counts after COVID-19 infection in cITP patients treated with TPO-RA; 12 the peak rise in platelet counts occurred 1-2 weeks after COVID-19 infection, and platelet counts returned to pre-infection levels 3-4 weeks after infection. [10][11][12] However, this study indicated that, in the platelet count increased group, platelet counts elevation mostly occurred within 1 month after COVID-19 infection; the platelet count was slightly increased at 3 months after infection and the platelet count was still at a higher level at 6 months after infection when compared with that before infection (p=0.180, 0.040). TPO-RA use synergized with cytokines and lymphopenia caused by COVID-19 infection might contribute to the elevation of platelet count in ITP patients.…”

“…10,11 A single-center observational cohort study conducted at Beijing Children's Hospital demonstrates a transient rise in platelet counts after COVID-19 infection in cITP children treated with TPO-RA. 12 However, in adult ITP patients, there have been no relevant reports exploring the incidence, clinical characteristics, and risk factors of platelet elevation after COVID-19 infection. To further verify and explore the impact of COVID-19 infection in adult ITP patients, this study retrospectively analyzed the clinical data of adult patients with ITP in our center from December 2022 to February 2023 to provide a reference for the management of adult ITP patients during the COVID-19 pandemic.…”

Recommendations for the Clinical Approach to Immune Thrombocytopenia: Spanish ITP Working Group (GEPTI)

“…In other cases, thrombocytosis occurs very rarely. Nevertheless, close monitoring is advisable [130][131][132][133]. If the infection leads to a relapse of the thrombocytopenia, patients should be administered IVIg if the drop in platelet counts is severe, and platelets should be transfused in the event of bleeding.…”