Contributions
Abstract: EP1152
Type: E-Poster Presentation
Session title: Platelet disorders
Background
Immune thrombocytopenia (ITP) is an acquired immune disorder characterised by a platelet count < 100x109/L, leading to an increased bleeding risk. Infectious diseases, especially from viral agents, may potentially cause ITP. Since the novel pandemic caused by severe acute respiratory syndrome coronavirus-2(SARS-CoV2), known as COVID-19, has started in February 2020, different cases of ITP in patients affected by SARS-CoV2 have been reported. The management of COVID-19 in patients with simultaneous or previous ITP can be challenging because of the great involvement of the haemostatic system in this viral infection.
Aims
To describe the management and outcome of patients with newly diagnosed (ND), chronic and previous ITP, infected by COVID-19.
Methods
Data were collected from clinical charts and updated through telephone contacts. All patients expressed their agreement to participate to the study.
Results
Seventeen patients had RT-PCR confirmed SARS-CoV2 infection on a nasopharyngeal swab (October 2020-January 2021). Six patients were male (35.3%) and 11 female (64.7%). The median age was 57 years (range 30-90). At the time of the COVID-19 infection, as regards ITP, patients were grouped as follows: 3 had simultaneous ND ITP (17.6%) and 1 experienced a relapse (5.8%) (median platelet count 5.5x109/L; range 2-30x109/L); 7 had chronic ITP on treatment (41.2%) (eltrombopag, n=5; romiplostim, n=1; prednisone, n=1) and 2 patients had stable chronic ITP off-therapy (11.8%) (median platelet count 63x109/L; range 30-100x109/L); 4 patients had a previous ITP on follow-up (FU) (23.6%) (platelet count >100x109/L). Fever, anosmia, dysgeusia, articular pain and mild-to-moderate respiratory distress were considered typically COVID19-related symptoms. Overall, 15 patients were symptomatic: 11 had only COVID19-related symptoms (64.8%), 1 presented with isolated mucocutaneous bleeding (5.8%) and 3 reported both (17.6%). Two patients did not refer any symptoms throughout the course of the infection (11.8%). Six cases required hospitalization (35.3%): 3 for acute decrease of platelet count and bleeding symptoms (17.6%) (ND ITP=2; ITP relapse=1); 3 for pneumonia (17.6%) (ND ITP=1; chronic ITP on treatment=1; ITP on FU=1). Patients with bleeding symptoms were responsive to dexamethasone (40 mg/day, days 1-4) and immunoglobulins (1 g/kg). Patients with pneumonia were successfully treated with antibiotics and oral corticosteroids. The median duration of stay in the hospital was 10.5 days (range 3-20). Eleven patients recovered at home without any bleeding; they did not show any significant change in the platelet count at the first evaluation after quarantine (64.7%). Twelve patients had previously received either steroids (n=8) or steroid+splenectomy (n=4) (70.5%). Serious respiratory distress, requiring mechanic ventilation, was not recorded. Anti-thrombotic prophylaxis of COVID-related thromboembolism was not used and no cases of thrombosis were observed. The viral seroconversion was observed in all patients and no death occurred.
Conclusion
In our experience, ND ITP triggered by COVID-19 has been responsive to immunoglobulins and steroids. Overall outcome has been favourable also for COVID-19 patients with a stable off-therapy or on treatment ITP.
Keyword(s): COVID-19, Immune thrombocytopenia (ITP)
Abstract: EP1152
Type: E-Poster Presentation
Session title: Platelet disorders
Background
Immune thrombocytopenia (ITP) is an acquired immune disorder characterised by a platelet count < 100x109/L, leading to an increased bleeding risk. Infectious diseases, especially from viral agents, may potentially cause ITP. Since the novel pandemic caused by severe acute respiratory syndrome coronavirus-2(SARS-CoV2), known as COVID-19, has started in February 2020, different cases of ITP in patients affected by SARS-CoV2 have been reported. The management of COVID-19 in patients with simultaneous or previous ITP can be challenging because of the great involvement of the haemostatic system in this viral infection.
Aims
To describe the management and outcome of patients with newly diagnosed (ND), chronic and previous ITP, infected by COVID-19.
Methods
Data were collected from clinical charts and updated through telephone contacts. All patients expressed their agreement to participate to the study.
Results
Seventeen patients had RT-PCR confirmed SARS-CoV2 infection on a nasopharyngeal swab (October 2020-January 2021). Six patients were male (35.3%) and 11 female (64.7%). The median age was 57 years (range 30-90). At the time of the COVID-19 infection, as regards ITP, patients were grouped as follows: 3 had simultaneous ND ITP (17.6%) and 1 experienced a relapse (5.8%) (median platelet count 5.5x109/L; range 2-30x109/L); 7 had chronic ITP on treatment (41.2%) (eltrombopag, n=5; romiplostim, n=1; prednisone, n=1) and 2 patients had stable chronic ITP off-therapy (11.8%) (median platelet count 63x109/L; range 30-100x109/L); 4 patients had a previous ITP on follow-up (FU) (23.6%) (platelet count >100x109/L). Fever, anosmia, dysgeusia, articular pain and mild-to-moderate respiratory distress were considered typically COVID19-related symptoms. Overall, 15 patients were symptomatic: 11 had only COVID19-related symptoms (64.8%), 1 presented with isolated mucocutaneous bleeding (5.8%) and 3 reported both (17.6%). Two patients did not refer any symptoms throughout the course of the infection (11.8%). Six cases required hospitalization (35.3%): 3 for acute decrease of platelet count and bleeding symptoms (17.6%) (ND ITP=2; ITP relapse=1); 3 for pneumonia (17.6%) (ND ITP=1; chronic ITP on treatment=1; ITP on FU=1). Patients with bleeding symptoms were responsive to dexamethasone (40 mg/day, days 1-4) and immunoglobulins (1 g/kg). Patients with pneumonia were successfully treated with antibiotics and oral corticosteroids. The median duration of stay in the hospital was 10.5 days (range 3-20). Eleven patients recovered at home without any bleeding; they did not show any significant change in the platelet count at the first evaluation after quarantine (64.7%). Twelve patients had previously received either steroids (n=8) or steroid+splenectomy (n=4) (70.5%). Serious respiratory distress, requiring mechanic ventilation, was not recorded. Anti-thrombotic prophylaxis of COVID-related thromboembolism was not used and no cases of thrombosis were observed. The viral seroconversion was observed in all patients and no death occurred.
Conclusion
In our experience, ND ITP triggered by COVID-19 has been responsive to immunoglobulins and steroids. Overall outcome has been favourable also for COVID-19 patients with a stable off-therapy or on treatment ITP.
Keyword(s): COVID-19, Immune thrombocytopenia (ITP)