Abstract Number: PB1374
Meeting: ISTH 2020 Congress
Background: Reports on cytomegalovirus (CMV)-related thrombocytopenia in immunocompetent patients are scarce, possibly because CMV infection in healthy adults is usually asymptomatic. Here, we describe 5 new cases of CMV-related thrombocytopenia and review cases reported in the literature.
Aims: To describe characteristics and outcome of immuno-competent patients with acute CMV-related thrombocytopenia.
Methods: Clinical data were retrieved from the patients´ files and merged with data reported in previous publications.
Results: Thirty-one immunocompetent patients (five new cases and 28 previously described) were identified. Their median age was 33 years (range 18-81), 71% were men, 77% presented with CMV-related symptoms (e.g., malaise, fever), 48% had an enlarged spleen, 95% had atypical lymphocytes in peripheral blood, and 68% had an elevated transaminase level. Bone marrow examinations revealed increased or normal numbers of megakaryocytes in 96% of cases. Two patients had spontaneous resolution and 29 (94%) patients underwent treatment. The response rate to steroid-containing regimens (n=27) and steroid monotherapy (n=17) as 1st-line therapy was 34% and 17%, respectively. The response rate in polymerase chain reaction-proven cases was 2/15 (13%). The response rate to intravenous immunoglobulins (IVIG) was 29%. Five patients were treated with thrombopoietin (TPO) receptor agonists, with a 60% response rate. Ten patients were treated with ant-CMV therapy with a 80% response rate (table 1).
Conclusions: CMV should be considered in immunocompetent patients presenting with thrombocytopenia. Response rates to steroids and IVIG are lower than reported for immune-mediated thrombocytopenia unrelated to CMV infection. Anti-CMV therapy and TPO receptor agonists have better response rates.
|1st-line treatment||number of patients (%)||response rate n(%)|
|Steroid-containing regimen||27 (93)||9 (33)|
|Steroids only||19 (66)||5 (17)|
|Steroids + IVIG||4 (14)||3 (75)|
|Steroids + anti-CMV||1 (3)||1 (100)|
|IVIG only||2 (7)||1 (50)|
[Table 1: 1st-line treatment and response]
To cite this abstract in AMA style:Shragai T, Lebel E, Deshet D, Varon D, Avivi I, Kirgner I, Sarid N. Characteristics and Outcome of Patients with Thrombocytopenia Secondary to Acute Cytomegalovirus Infection: Case Series and Literature Review [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/characteristics-and-outcome-of-patients-with-thrombocytopenia-secondary-to-acute-cytomegalovirus-infection-case-series-and-literature-review/. Accessed January 23, 2022.
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