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Background/Case Studies: Thrombocytopenia is a well-described complication of COVID-19, with numerous proposed mechanisms among which is immune thrombocytopenia (ITP). There are limited data on the characteristics and impact of COVID-19 on patients with previously diagnosed ITP.

Study Design/Methods: This is a retrospective review of all chronic ITP patients who were diagnosed with COVID-19 between 03/2020 and 01/2022 at a tertiary care center. The study was approved by the IRB. Patients with secondary thrombocytopenia, missing data, and unavailable follow up after COVID-19 diagnosis, were excluded. Demographic data, comorbidities, clinico-laboratory findings before and after COVID-19 diagnosis, management of COVID-19 and outcome were collected. Analyses were performed using SPSS; a p value of <0.05 was considered significant. Results were presented as median plus range, mean +/- standard deviation, or percentages as indicated. Variables were compared using the independent two-sample Student t-test for continuous variables, and the Pearson's Chi-square test or Fisher's exact test for categorical variables. Early mortality was defined as death from any cause within 30 days of admission.

Results/Findings: 45 patients were included. The median age was 66 (32–93) years; 27 (60%) were females. 28(62%) patients were Caucasian. The median time from ITP diagnosis to COVID-19 was 5 (1–35) years. A 27 (60%) patients required treatment for ITP before COVID-19, and only 4 patients were on low-dose prednisone at the time of COVID-19 diagnosis. The most common symptoms of COVID-19 were shortness of breath (53%), fever (31%), and cough (22%). 29 (64%) patients were hospitalized with 12 of them requiring ICU care. Median time of hospitalization was 8 (2–45) days. COVID-19 specific treatments included steroids (42%), remdesivir (24%), chloroquine (9%), azithromycin (9%), and tocilizumab (2%). Three patients had thrombosis (2 DVTs, and 1 DVT and PE), 2 had intracranial bleeding, and 3 had mucosal bleeding. Early mortality rate was 15.6%; death was attributed to respiratory failure in 3 patients, multi-organ failure in 3 patients, and cardiac arrest in 1 patient. None of the analyzed parameters (gender, ethnicity, age, comorbidities, severity of thrombocytopenia, thrombotic or bleeding events) was associated with ICU admission or early mortality. Patients' platelet count before COVID-19 diagnosis did not differ from the platelet count at the time of COVID-19 diagnosis with a mean platelet count of 108.5 (+/- 49.0) and 93.8 (+/- 92.8) (p = 0.299), respectively. In addition, there was no significant difference in the platelet before COVID-19 and after recovery. Conclusion: Thrombocytopenia of chronic ITP patients did not worsen during COVID-19 infection or after recovery. Mortality of chronic ITP patients due to COVID-19 was not different from reported mortality of hospitalized COVID-19 patients. Our findings should be validated in larger cohorts.



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