Background: The COVID-19 pandemic has infected 116 million people to date. Hematologic complications of COVID-19 are common, and associated thrombocytopenia correlates with disease severity. Immune thrombocytopenia (ITP) secondary to COVID-19 has been reported, but the characteristics of this novel entity remain unknown.

Aims: To elucidate the demographics, clinical presentations, COVID-19 symptoms, management strategies, complications, and outcomes of patients with ITP secondary to COVID-19. While case series and reviews of ITP secondary to COVID-19 have been published (PMID: 32677007, 32984764), this comprehensive review provides a greater sample size and details regarding management and outcomes.

Methods: A comprehensive literature review was performed through 2/28/21 in PubMed and Embase using keywords related to ITP and COVID-19. Articles were excluded based on diagnostic uncertainty, duplication, or irrelevance. Statistical analyses were performed using IBM SPSS Version 27.0. Means and SD reported.

Results: Among 106 unique articles identified, 38 were reviewed. Patient demographics and clinical presentations are presented in Table 1. Management and outcomes are described in Table 2.

Demographics and Presentation

Management and Outcomes

Conclusions: SARS-CoV-2 is a virologic trigger of ITP. Middle-aged adults are most commonly affected, with no gender predilection. Autoimmune disease and cancer are common comorbidities. Mucocutaneous bleeding is the most common presenting symptom. While most patients had COVID-19 symptoms at the time of diagnosis, 12.6% were post-symptomatic and 7.9% never experienced symptoms. Treatment regimens including TPO-RAs were most effective in obtaining a complete response, and steroids may have been more effective than IVIG in the reported population. Treatment complications were rare. Patients with chronic and newly diagnosed ITP had similar presentations and outcomes. Prognostic data were reassuring: the vast majority of patients had complete or partial responses to therapy, and only 1 death was attributable to ITP. Rates of major bleeding were similar to typical ITP. Steroids may be a favorable treatment option given their apparent efficacy for both ITP and COVID-19.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/itp-secondary-to-covid-19-a-comprehensive-review-of-reported-cases/