IMMUNE THROMBOCYTOPENIA ONSET AND RELAPSE DURING THE COVID19 PANDEMIC. A MONOCENTER STUDY. ITP and COVID19 infection and vaccination
Main Article Content
Keywords
Immune Thrombocytopenia, COVID19, vaccine, SARS-CoV-2
Abstract
BACKGROUND AND OBJECTIVES
Several infections and vaccinations can provoke immune thrombocytopenia (ITP) onset or relapse. Information on ITP epidemiology and management during the Covid19 pandemic is scarce.
In a large monocenter ITP cohort, we assessed incidence of and risk factors for: 1) ITP onset/relapse after Covid19 vaccination/ infection; 2) Covid19 infection.
METHODS
Information on date/type of anti-Covid19 vaccine, platelet count before and within 30 days from vaccine and date/grade of Covid19, was collected via phone call or during hematological visits.
ITP relapse was defined as a drop in PLT count within 30 days from vaccination, compared to PLT count before vaccination that required a rescue therapy OR a dose increase of an ongoing therapy OR a PLT count <30 x109/L with ≥20% decrease from baseline.
RESULTS
Between February 2020 and January 2022, 60 new ITP diagnosis were observed (30% related to Covid19 infection or vaccination). Younger and older age were associated to higher probability of ITP related to Covid19 infection (p=0.02) and vaccination (p=0.04), respectively. Compared to Covid19-unrelated ITP, Infection- and vaccine-related ITP had lower response rates (p=0.03) and required more prolonged therapy (p=0.04), respectively.
Among the 382 patients with known ITP at pandemic start, 18.1% relapsed; relapse was attributed to Covid19 infection/vaccine in 52.2% of the cases. The risk of relapse was higher in patients with active disease (p<0.001) and previous vaccine-related relapse (p=0.006).
Overall, 18.3% of ITP patients acquired Covid19 (severe in 9.9%); risk was higher in unvaccinated patients (p<0.001).
CONCLUSIONS
All ITP patients should receive ≥1 vaccine dose and laboratory follow-up after vaccination, with case-by-case evaluation of completion of vaccine program if vaccine-related ITP onset/relapse, and with tempestive initiation of antiviral therapy in unvaccinated patients.
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References
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