Development of Immune Thrombocytopenia as a Result of Past COVID-19 Illness
Immune thrombocytopenia (ITP) developing secondary to COVID-19 is a completely new experience in clinical practice. A brief summary on this topic, describing incidence and response to treatment, was published last year by authors from Cleveland.
Connection Between ITP and COVID-19
Immune thrombocytopenia is an acquired disease characterized by thrombocytopenia associated with the presence of antibodies against platelets. The causes of ITP can be varied, including different infections. Recently, the newly recognized infectious disease COVID-19 has been described as one of the causes associated with ITP, especially in cases of severe progress, where a cytokine storm and the production of numerous autoantibodies is observed.
Experience from One Facility
Doctors from Cleveland Clinic published their report on 11 patients who developed ITP out of 3255 treated cases of COVID-19, representing 0.34% of all treated in this group, of whom 63.6% were men with a median age of 63 years. The median time from COVID-19 diagnosis to the onset of ITP symptoms was 10 days, although it appeared in 2 patients one month after the first COVID-19 symptoms and in 1 case nearly 4 months later.
Bleeding was observed in 7 patients. Clinically significant bleeding occurred in only 1 patient with ITP. No patient developed bleeding during therapeutic administration of heparin. For most patients, standard first-line therapy—corticosteroids and intravenous immunoglobulins (IVIG)—was effective.
Complete remission was achieved in 5 patients and response to treatment in 3. The median platelet recovery time was 4 days (range 2−7). In 3 patients, thrombopoietin receptor agonist (TPO-RA) was administered later in the treatment course, in 1 case due to relapse after achieving remission. 2 patients did not respond to treatment, and both died, although bleeding was not the cause of death.
Conclusion
According to this published experience, ITP in the context of COVID-19 typically develops after the first week of symptoms. Most patients exhibit mild bleeding manifestations. Standard therapy in this situation consists of glucocorticoids and IVIG, with very good treatment response. The role of modern preparations from the TPO-RA group in this indication needs further exploration.
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Source: Kewan T., Gunaratne T. N., Mushtaq K. et al. Outcomes and management of immune thrombocytopenia secondary to COVID-19: Cleveland Clinic experience. Transfusion 2021 Jul; 61 (7): 2014−2018, doi: 10.1111/trf.16368.
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