Background: Although immune thrombocytopenia (IT) is uncommon, it has been described as one of the complications secondary to infection by SARS-CoV-2, probably secondary, amongst other factors, to the underlying immune dysregulation. The very few cases reported in the literature show excellent responses to corticoid therapy.

Aims: The objective of this study is to show our experience with 2 patients who had severe symptomatic corticoid-refractory IT as a complication of COVID-19.

Methods: A descriptive, single-centre study that shows our experience with 2 patients diagnosed with severe COVID-19 and a long-term stay at the Intensive Care Unit (ICU), who had severe symptomatic corticoid-refractory IT, an uncommon manifestation according to the very few series reported to date.

Results: Two patients (women aged 65-67 years) with no relevant medical history, diagnosed in 03-2020 and 04-2020, respectively, with bibasal pneumonia secondary to severe COVID-19, needing stay at the ICU and assisted ventilation and long-term stay. On discharge they had severe IT associated with skin bleeding events, initially treated with oral prednisone mg/kg/day plus unspecific IVIg g/kg/day, initially obtaining a good response, but followed by early loss of response in both cases. It was decided to switch protocol to IV dexamethasone 40 mg for 4 days plus unspecific IVIg g/kg/day every 15 days, of which they received 3 cycles, without response and with increased skin stigmata of bleeding. Second-line treatment was started with TPO analogues (oral eltrombopag 50 mg/day, with dose escalation to 75 mg/day), obtaining haematological response on day +7 of start and complete remission on day +21 of treatment. Currently complete response persists, with no documented adverse events.

Conclusions: Although uncommon, corticoid-refractory IT is a documented bleeding diathesis in severe COVID-19. Our experience shows that the early start of TPO analogues (in the absence of response to corticoid therapy) is an effective, well-tolerated option in patients with this complication.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/immune-thrombocytopenia-refractory-to-corticoid-therapy-secondary-to-covid-19-a-single-centre-experience/