Immune Thrombocytopenia Secondary to COVID-19: a Systematic Review
- PDF / 1,124,086 Bytes
- 11 Pages / 595.276 x 790.866 pts Page_size
- 27 Downloads / 200 Views
COVID-19
Immune Thrombocytopenia Secondary to COVID-19: a Systematic Review Sukrita Bhattacharjee 1
&
Mainak Banerjee 2
Accepted: 10 September 2020 # Springer Nature Switzerland AG 2020
Abstract Immune thrombocytopenia, often known as immune thrombocytopenic purpura (ITP), has emerged as an important complication of COVID-19. A systematic review was done to analyze the clinical profile and outcomes in a total of 45 cases of new-onset ITP in COVID-19 patients described in literature until date. A comprehensive approach is essential for diagnosing COVID-19associated ITP after excluding several concomitant factors that can cause thrombocytopenia in COVID-19. Majority of ITP cases (71%) were found to be elderly (> 50 years) and 75% cases had moderate-to-severe COVID-19. Three patients (7%) were in the pediatric age group. Reports of ITP in asymptomatic COVID-19 patients (7%) underscore the need for COVID-19 testing in newly diagnosed patients with ITP irrespective of COVID-19 symptoms amid this pandemic. ITP onset occurred in 20% cases 3 weeks after onset of COVID-19 symptoms, with many reports after clinical recovery. SARS-CoV-2-mediated immune thrombocytopenia can be attributed to the underlying immune dysregulation, susceptibility mutations in SOCS 1, and other mechanisms, including molecular mimicry, cryptic antigen expression, and epitope spreading. No bleeding manifestations were reported in 31% cases at diagnosis. Severe life-threatening bleeding was uncommon. One case of mortality was attributed to intracranial hemorrhage. Secondary Evans syndrome was diagnosed in one case. Good initial response to short course of glucocorticoids and intravenous immunoglobulin has been found with the exception of delayed lag response in one case. Thrombopoietin receptor agonist usage as a second-line agent has been noted in few cases for short duration with no adverse events. In the relatively short follow-up period, four relapses of ITP were found. Keywords COVID-19 . ITP . Bleeding . Purpura . Hematological complication . Low platelet
Introduction A novel coronavirus disease (COVID-19) pandemic, caused by severe acute respiratory syndrome corona virus (SARSCoV-2), has affected over 21 million people worldwide since its inception. Acute respiratory distress syndrome (ARDS), cardiac complications, and thromboembolic events have contributed to majority of the disease mortality. Among Sukrita Bhattacharjee and Mainak Banerjee contributed equally to this work. This article is part of the Topical Collection on Covid-19 * Sukrita Bhattacharjee [email protected] 1
Department of Hematology, Institute of Hematology and Transfusion Medicine, Medical College and Hospital, Kolkata, India
2
Institute of Post Graduate Medical Education and Research, Kolkata, India
hematological complications, a systemic hyperinflammatory state resembling secondary hemophagocytic lymphohistiocytosis (HLH) and distinct coagulopathy resembling hypercoagulable stage of disseminated intravascular coagulation (DIC) have been reported [1]. The incid
Data Loading...