Immune Thrombocytopenia Onset and Relapse During the COVID-19 Pandemic. A Monocenter Study.

IF 2 4区医学 Q3 HEMATOLOGY

Mediterranean Journal of Hematology and Infectious Diseases Pub Date : 2023-01-01 DOI:10.4084/MJHID.2023.029

Giuseppe Auteri, Simona Paglia, Camilla Mazzoni, Mattia Biondo, Marta Venturi, Andrea Davide Romagnoli, Daniela Bartoletti, Michele Cavo, Nicola Vianelli, Francesca Palandri

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引用次数: 0

Abstract

Background and objectives: Several infections and vaccinations can provoke immune thrombocytopenia (ITP) onset or relapse. Information on ITP epidemiology and management during the Covid-19 pandemic is scarce. In a large monocenter ITP cohort, we assessed the incidence and risk factors for: 1) ITP onset/relapse after Covid19 vaccination/infection; 2) Covid19 infection.

Methods: Information on the date/type of anti-Covid-19 vaccine, platelet count before and within 30 days from the vaccine, and date/grade of Covid-19 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 ×10⁹/L with ≥20% decrease from baseline.

Results: Between February 2020 and January 2022, 60 new ITP diagnoses were observed (30% related to Covid-19 infection or vaccination). Younger and older ages were associated with a higher probability of ITP related to Covid19 infection (p=0.02) and vaccination (p=0.04), respectively. Compared to Covid-19-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 the pandemic start, 18.1% relapsed; relapse was attributed to Covid-19 infection/vaccine in 52.2%. 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 a case-by-case evaluation of completion of the vaccine program if vaccine-related ITP onset/relapse and with tempest initiation of antiviral therapy in unvaccinated patients.

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查看原文本刊更多论文

COVID-19大流行期间免疫性血小板减少症的发病和复发。单中心研究。

背景和目的:几种感染和疫苗接种可引起免疫性血小板减少症(ITP)的发作或复发。关于Covid-19大流行期间ITP流行病学和管理的信息很少。在一个大型单中心ITP队列中，我们评估了以下因素的发病率和危险因素:1)covid - 19疫苗接种/感染后ITP发病/复发;2)新冠肺炎感染。方法:通过电话或血液科就诊收集患者抗新冠肺炎疫苗接种日期/类型、接种前及接种后30天内血小板计数、Covid-19日期/分级等信息。ITP复发定义为接种疫苗后30天内PLT计数下降，与接种疫苗前的PLT计数相比，需要进行挽救治疗，或正在进行的治疗剂量增加，或PLT计数9/L，比基线下降≥20%。结果:2020年2月至2022年1月，新增ITP诊断60例(30%与Covid-19感染或疫苗接种有关)。年龄较小和年龄较大的人发生与covid - 19感染(p=0.02)和接种疫苗(p=0.04)相关的ITP的可能性更高。与与covid -19无关的ITP相比，感染和疫苗相关的ITP的应答率较低(p=0.03)，需要更长的治疗时间(p=0.04)。在大流行开始时已知的382例ITP患者中，18.1%复发;52.2%的复发归因于Covid-19感染/疫苗。结论:所有ITP患者在接种疫苗后应接受≥1次疫苗剂量和实验室随访，如果疫苗相关的ITP发病/复发，应逐个评估疫苗计划的完成情况，未接种疫苗的患者应立即开始抗病毒治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Mediterranean Journal of Hematology and Infectious Diseases Medicine-Hematology

CiteScore

4.20

自引率

6.20%

发文量

113

审稿时长

12 weeks

期刊介绍： Reciprocal interdependence between infectious and hematologic diseases (malignant and non-malignant) is well known. This relationship is particularly evident in Mediterranean countries. Parasitosis as Malaria, Leishmaniosis, B Hookworms, Teniasis, very common in the southeast Mediterranean area, infect about a billion people and manifest prevalently with anemia so that they are usually diagnosed mostly by experienced hematologist on blood or bone marrow smear. On the other hand, infections are also a significant problem in patients affected by hematological malignancies. The blood is the primary vector of HIV infection, which otherwise manifest with symptoms related to a reduction in T lymphocytes. In turn, infections can favor the insurgency of hematological malignancies. The causative relationship between Epstein-Barr virus infection, Helicobacter pylori, hepatitis C virus, HIV and lymphoproliferative diseases is well known.