Background: Immune thrombocytopenic purpura (ITP) is a bleeding disorder that is characterized by transient or persistent thrombocytopenia. ITP may be classified as primary or secondary; but in many cases, patients with primary or secondary immune thrombocytopenic purpura are treated similarly. ITP can also be classified as: newly diagnosed (early ITP), persistent and chronic ITP. Diagnosing ITP secondary to COVID-19 can be a major challenge for clinicians due to various concomitant factors associated with SARS-CoV-2 infection. 

Aims: To present the challenges of ITP diagnosis and treatment in actual pandemic context. 

Methods: We present a series of four cases of ITP and their challenges in context of SARS Cov-2 infection and a short review of literature data.

Results: Case 1: a patient with a history of ITP and splenectomy presents a relapse of ITP associated with a mild form COVID-19 disease. Case 2: a newly diagnosed ITP in a pregnant patient associated with asymptomatic form of COVID-19 disease. Case 3: a chronic ITP with splenectomy in treatment with romiplostim and stable platelet count presents a severe thrombocytopenia and later became refractory to romiplostim in the mild form COVID-19 disease. Case 4: a newly diagnosed ITP secondary to a moderate form of SARS CoV- 2 infection that evolved with severe thrombocytopenia and bleeding diathesis. We note that in all four cases, severe thrombocytopenia was found even if a severe acute respiratory syndrome was not discussed.

Conclusions: Although thrombotic events are most commonly described as being associated with COVID-19 disease, immune thrombocytopenia with severe hemorrhagic manifestations is a clinical reality in the current pandemic context. We highlighted that viral infection with SARS-CoV-2 could be a critical pathogenic factor for ITP.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/clinical-impact-of-immune-thrombocytopenic-purpura-in-the-context-of-sars-cov-2-infection/