COVID-19 and Immune Thrombocytopenic Purpura − Spanish Experience Suggests Surprising Connections
In a retrospective study examining the impact of COVID-19 on immune thrombocytopenic purpura, Spanish authors surprisingly observed a paradoxical effect.
Introduction
Immune thrombocytopenic purpura is an acquired disorder where blood platelets are destroyed. In many cases, the etiology is unknown; however, as with other autoimmune diseases, certain viruses have been identified as potential triggers − either in the initial phase or during relapse.
COVID-19, caused by the SARS-CoV-2 coronavirus, can influence blood clotting or induce thrombocytopenia.
Study Population
The data from Spanish authors come from a cohort of 142 ITP patients monitored at a single center. They focused on ITP patients diagnosed with COVID-19 (nasopharyngeal swab or serologically) between March 1 and April 30. In total, there were 10 COVID-19-positive patients in this cohort (7 men), with a median age of 75 years (range 41−94). Eight patients had chronic ITP, and 2 had newly diagnosed ITP episodes associated with COVID-19. Four chronic ITP patients were on thrombopoietin receptor agonists (TPO-RA) at the time of the diagnosed infection, and another 4 were untreated.
Main Findings
At the time of the COVID-19 diagnosis, half of the patients had platelet counts < 100×109/l (range 2−86×109/l), and lymphopenia was observed in 5 patients. During the first week post-COVID-19 diagnosis, thrombocytosis with platelet counts > 400×109/l was observed in 5 patients. All patients reached platelet counts > 100×109/l by the 7th day after infection detection, with a downward trend in the subsequent weeks. Thrombocytosis lasted from 1 to 6 weeks.
Among chronic ITP patients, treatment adjustments were necessary in some cases due to thrombocytosis. One patient without any specific treatment required short-term acetylsalicylic acid (ASA) administration for thrombocytosis > 700×109/l. Another patient with an ITP relapse 14 days before the COVID-19 diagnosis received corticosteroids, intravenous immunoglobulins (IVIG), and TPO-RA with a good response. During the first 7 days post-COVID-19 diagnosis, the platelet count peaked at 575×109/l, allowing for temporary suspension of specific treatment and later dosage adjustment.
In 2 patients with newly diagnosed ITP at the time of COVID-19 diagnosis, a faster treatment response was noted compared to classical ITP. Complete blood count normalization occurred within 7 days for both patients.
Conclusion
In this small observational retrospective study, an upward trend in platelet counts was observed in patients with chronic ITP and concurrent SARS-CoV-2 infection. Whether this is a consequence of reduced immune activity due to lymphopenia remains uncertain. Possible explanations include immune deregulation induced by the infection.
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Source: de la Cruz-Benito B., Rivas-Pollmar M. I., Román Alvarez M. T. et al. Paradoxical effect of SARS‐CoV‐2 infection in patients with immune thrombocytopenia. Br J Haematol 2020 Sep 10, doi: 10.1111/bjh.17077 [Epub ahead of print].
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