Events of Immune Thrombocytopenic Purpura (ITP) Among COVID-19-positive Adults in the United States; an Analysis via the National Inpatient Sample for Cases Between April to November 2020 (preprint)

Various cases of immune thrombocytopenic purpura (ITP) were reported among COVID-19-positive patients in the literature. We used the National Inpatient Sample (NIS) to evaluate the odds of ITP among COVID-19 patients in the United States between April and November 2020. Females (vs. Males), Whites (vs. other races), and the presence of multiple comorbidities such as chronic kidney disease, cirrhosis, prior stroke, HIV, obesity, cachexia, neoplasms, and autoimmune conditions showed higher odds of ITP. Meanwhile, those with diabetes and peripheral vascular disease and covered by private insurance (vs. Medicare) were less likely to experience ITP while being positive for the virus. Events of ITP also led to a higher mortality risk in COVID-19-positive patients.

The impact of COVID-19 vaccines on patients with immune thrombocytopenic purpura:A protocol for a systematic review and meta-analysis (preprint)

Abstract Introduction Immune thrombocytopenic purpura (ITP) is characterized by a decrease in platelet counts and can be triggered by various factors, such as viral infections and vaccinations. Concerns have emerged regarding potential links between the vaccines for COVID-19 and the worsening of ITP. This systematic review aims to comprehensively assess the impact of COVID-19 vaccines on patients with ITP, including associated risks and outcomes. Methods and Analysis A thorough search will be conducted across multiple electronic databases, including PubMed, MEDLINE, EMBASE, Cochrane Library, CNKI, Wan Fang, VIP, and CBM, to identify pertinent studies. This study will encompass randomized controlled trials, cohort studies, case-control studies, and case series that assess the effects of COVID-19 vaccines on individuals with ITP. The primary outcome will center on alterations in platelet count, while secondary outcomes will encompass the occurrence of thromboembolic events, bleeding complications, recurrence rate of ITP, impact of ITP exacerbation, and adverse events. The data will be synthesized and subjected to meta-analysis using Review Manager Software (RevMan) V.5.3. Additionally, subgroup analyses will be conducted to investigate potential sources of heterogeneity.

Coronavirus and Post-COVID-19 Syndrome: A Systematic Review (preprint)

Coronavirus infectious Disease 2019 (COVID-19) was first reported in Wuhan, China, and with its rapidly mutating variants, it soon became a global concern. In response to the pandemic, intensive research and development efforts led to the development of six vaccines approved by the World Health Organization (WHO). Coronavirus is divided into four genera: alpha, beta, gamma and delta. Its unstable ssRNA resulted in multiple strains in a short period, which acted as a selection pressure for transmissibility. Sequelae of COVID-19 infection include multiple syndromes which have been reported at high incidence globally. Using the Cochrane guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), we present a systematic review of the most common syndromes reported. A total of 12 eligible studies were included in this review. Syndromes reported in the literature include immune thrombocytopenic purpura (ITP), viral encephalomyelitis, hemophagocytic lymphohistiocytosis, thrombotic thrombocytopenic purpura (TTP), Guillain-Barre syndrome (GBS) and postural orthostatic tachycardia syndrome (POTS). We cover the hypothesized pathophysiology, presenting symptoms and treatment for each respective syndrome. We aim to discuss coronavirus and its variants to provide a foundation on which to examine the syndromes manifested after COVID-19 infection (post-COVID-19 syndrome).

Thrombotic Thrombocytopenic Purpura Following ChAdOx1 nCov-19 Vaccination: A Case Report (preprint)

Vaccine-associated thrombotic thrombocytopenic purpura (TTP) is a rare type of acquired TTP recently reported after COVID-19 vaccination. Merely four cases are ascribed to the ChAdOx1 nCoV-19 vaccine in the medical literature till the preparation of this study. In this case report, we describe a 43-year-old man who developed symptoms of TTP four days after receiving the second dose of the ChAdOx1 nCoV-19 vaccine. Peripheral blood smear demonstrated multiple schistocytes. Given a high plasmic score, he received plasma exchange, corticosteroids, and rituximab, and later, low ADAMTS 13 activity and high-titer ADAMTS inhibition antibody confirmed the diagnosis of COVID-19 vaccine-associated TTP. COVID-19 vaccine-associated TTP is an infrequent consequence of SARS-CoV-2 vaccination but with a substantial mortality rate which must be considered as one of the crucial differential diagnoses of post-COVID-19 vaccine thrombocytopenia besides vaccine-induced immune thrombotic thrombocytopenia and Immune thrombocytopenic purpura.

Successful systemic lysis therapy of a floating carotid thrombus in an acute stroke patient with known immune thrombocytopenic purpura on ongoing eltrombopag therapy and acute COVID-19 infection: A case report (preprint)

Background: Patients with immune thrombocytopenic purpura (ITP) under eltrombopag therapy are vulnerable to thrombotic disbalance either by disease and by therapy-related hypercoagulability. Vascular events such as the development of a free-floating carotid thrombus are known rare complications of acute COVID-19 infections due to an endothelial inflammation and underlying hypercoagulable state. New focal neurological symptoms in patients at risk should be immediately followed by angiographic diagnostics and, if necessary, proceed with the appropriate treatment immediately. Case presentation: Here we report a case of a 38-old female with a medical history of ITP and presence of COVID-19 infection presenting an acute sensorimotor hemiparesis of the right side while oneltrombopag therapy. Initial CT angiography revealed a free-floating thrombus of the left carotid artery. At admission, platelet number was significantly increased at 896/nl. After systemic lysis therapy the thrombus was fully dissolved. Follow-up diffusion-weighted imaging revealed multilocular cortical infarction of the left ACM territory. The patient soon recovered and was released with residual mild sensorimotor deficits of the right arm. Eltrombopag was paused at admission, platelet number was quickly normalizing and the patient was discharged with a daily intake of acetylsalicylic acid, eltrombopag in reduced daily dose and weekly control of platelet number for 3 months. Conclusions: This unique case enhances the need for caution in patients at vascular risk who exhibit an acute COVID-19 infection, and discusses thrombocytic derailment under thrombopoietin receptor agonist therapy associated with an acute COVID-19 infection.

[Development of thrombocytopenic purpura following BNT162b2 mRNA COVID-19 vaccination].

Because the coronavirus disease 2019 (COVID-19) pandemic is still rampant, vaccination is being promoted worldwide. However, the safety of various COVID-19 vaccines remains poorly understood. We herein report the case of a 37-year-old woman who experienced thrombocytopenia following BNT162b2 mRNA COVID-19 vaccination. The patient presented with purpura on the extremities 10 days after the first vaccination. She had marked thrombocytopenia and no thrombosis. Thrombocytopenia resolved spontaneously. Given the possibility of occurrence of post-vaccination thrombocytopenia, vaccinated persons should be instructed to consult a medical institution if they experience bleeding symptoms.

Severe immune thrombocytopenic purpura in critical COVID-19: a case report (preprint)

Purpose: COVID-19 is a new disease with many undescribed clinical manifestations. Material and methods: We report herein a case of severe immune thrombocytopenic purpura (ITP) in a critical COVID-19 patient.Results: A patient presented a severe episode of immune thrombocytopenia (< 10 x 109/L) 20 days after admission for a critical COVID-19. This thrombocytopenia was associated with a life-threatening bleeding. Response to first-line therapies was delayed as it took up to 13 days after initiation of intravenous immunoglobulin and high dose dexamethasone to observe an increase in platelet count. Conclusion: COVID-19 may be associated with late presenting severe ITP. Such ITP may also be relatively resistant to first-line agents. Hematological manifestations of COVID-19, such as the ones associated with life-threatening bleeding, must be recognized.