Idiopathic Thrombocytopenic Purpura with SARS-CoV-2 Infection

Idiopathic Thrombocytopenic Purpura

ITP is defined as a platelet count of < 100 × 10⁹/L. It usually manifests with petechiae and purpuric rashes. Many patients with ITP do not experience bleeding. ITP has been described following certain viral infections – hepatitis B and C, cytomegalovirus, varicella zoster, or HIV, and more recently with SARS-CoV-2.

Patient Characteristics

Of the 45 cases of ITP in individuals with confirmed SARS-CoV-2 presence, 58% were male. The median age was 62 years. Only 3 patients (7%) were in the pediatric population. 71% were over 50 years old and most had various comorbidities. In 1 case, the patient was a pregnant woman. 75% of those affected had a moderate to severe course of COVID-19, 18% had mild cases, and 7% were asymptomatic. ITP was detected with a median of 13 days after the COVID-19 diagnosis, and in 21.5% of cases, even after recovery from this infection.

Manifestations of ITP

At the time of diagnosis, 31% of patients had no signs of bleeding. Half of the patients had petechiae/purpura/ecchymosis, others experienced epistaxis, and 4 patients had intracranial bleeding, which was fatal in 1 case. One patient was diagnosed with secondary Evans syndrome (initially hemolytic anemia with newly associated ITP features).

Treatment Course

Good clinical responses were achieved with short-term administration of glucocorticoids and IV immunoglobulins, with one exception of a delayed response. Thrombopoietin receptor agonists were described in a few cases as second-line treatment without adverse events. Four relapses of ITP were observed.

Conclusion

ITP can develop after SARS-CoV-2 infection. When identifying this infection as the cause, a systematic approach is needed with the exclusion of several other factors and conditions that could induce thrombocytopenia. COVID-19-related ITP predominantly appeared in older individuals and patients with moderate to severe disease courses. Given several cases of ITP with asymptomatic SARS-CoV-2 infection, patients with ITP without a COVID-19 history should be tested for this infection. The authors point out that ITP can also appear after recovery from the infectious disease.

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Source: Bhattacharjee S., Mainak Banerjee M. Immune thrombocytopenia secondary to COVID-19: a systematic review. SN Compr Clin Med 2020 Sep 19: 1–11, doi: 10.1007/s42399-020-00521-8 [Epub ahead of print].