Can COVID-19 Increase Platelet in Adult Immune Thrombocytopenia During the TPO-RA Administration? A Real-World Observational Study

Figures & data

Table 1 Clinical Characteristics

Characteristics	All Patients (n=66)
Age [years, Mean±SD]	48±16
Gender [n (%)]
Male	25 (37.9)
Female	41 (62.1)
ITP status [n (%)]
Newly diagnosed ITP	11 (16.7)
Persistent ITP	16 (24.2)
Chronic ITP	39 (59.1)
History of autoimmune disease other than ITP [n (%)]
Undifferentiated connective tissue disease	6 (9.1)
Hypothyroidism	2 (3.0)
Sjogren syndrome	1 (1.5)
Evans syndrome	1 (1.5)
Splenectomy [n (%)]	3 (4.5)
ITP treatment lines before COVID-19 [n (%)]
Untreated	18 (27.3)
1	10 (15.1)
2	37 (56.1)
3	1 (1.5)
Treatment at the last visit before infection [n (%)]
No current treatment	23 (34.8)
Corticosteroid only	11 (16.7)
TPO-RA only	22 (33.3)
TPO-RA + corticosteroid	3 (4.5)
Other drug combinations*	7 (10.6)
Platelet count at the last visit before infection [×10^9/L, Median (range)]	64 (2–246)
Time from last visit before infection to infection [days, Median (range)]	16 (1–110)
Platelet count at the first visit after infection [×10^9/L, Median (range)]	40 (2–453)
Time from infection to first visit after infection [days, Median (range)]	16 (1–82)

Abbreviations: ITP, immune thrombocytopenia; TPO-RA, thrombopoietin receptor agonists. *Other drug combinations including Eltrombopag plus Cyclosporine (n=1), Eltrombopag plus Danazol (n=1), Hetrombopag plus Cyclosporine (n=1), Hetrombopag plus Corticosteroid plus Cyclosporine (n=1), Hetrombopag plus Corticosteroid plus Rituximab (n=1), Corticosteroid plus Azathioprine plus Danazol (n=1), Decitabine plus Chidamide (n=1).

Figure 1 COVID-19 infection and platelet count fluctuation. After COVID-19 infection, the platelet count of 19 patients increased by more than 20% compared with that before infection, of which 14 patients increased by more than 50%. The platelet count of 19 patients was stable which fluctuated within 20% compared with that before infection. Twenty-eight patients had a reduction in platelet count of more than 20%, of which 17 patients had a decrease of 50% or more.

Table 2 Clinical Characteristics of the Increased, Stable and Decreased Platelet Count Groups

Characteristics	Increased Platelet Count (n=19)	Stable Platelet Count (n=19)	Decreased Platelet Count (n=28)	P-value
Age [years, Mean±SD]	51±14	44±16	48±18	0.427
Gender [n (%)]				0.783
Male	6 (31.6)	8 (42.1)	11 (39.3)
Female	13 (68.4)	11 (57.9)	17 (60.7)
ITP status [n (%)]				0.532
Newly diagnosed ITP	2 (10.5)	3 (15.8)	6 (21.4)
Persistent ITP	4 (21.1)	3 (15.8)	9 (32.2)
Chronic ITP	13 (68.4)	13 (68.4)	13 (46.4)
ITP treatment lines before COVID-19 [n (%)]				0.079
Untreated	4 (21.1)	5 (26.3)	9 (32.1)
1	1 (5.3)	1 (5.3)	8 (28.6)
2	13 (68.4)	13 (68.4)	11 (39.3)
3	1 (5.3)	0	0
Treated with corticosteroid at the last visit before infection [n (%)]	4 (21.1)	5 (26.3)	8 (28.6)	0.936
Treated with TPO-RA at the last visit before infection [n (%)]	13 (68.4)	9 (47.4)	8 (28.6)	0.020
Platelet count at the last visit before infection [×10^9/L, Median (range)]	52 (2–207)	64 (14–246)	71 (14–227)	0.182
Time from last visit before infection to infection [days, Median (range)]	13 (1–67)	20 (4–86)	14 (2–110)	0.381
Platelet count at the first visit after infection [×10^9/L, Median (range)]	108 (19–453)	64 (12–259)	23 (2–90)	<0.001
Time from infection to first visit after infection [days, Median (range)]	20 (2–47)	21 (5–57)	13 (1–82)	0.104

Abbreviations: ITP, immune thrombocytopenia; TPO-RA, thrombopoietin receptor agonists.

Figure 2 Risk factors of ITP patients with increased platelet count after COVID-19 infection.

Figure 3 Changes of platelet counts in patients of platelet count increased group. Platelet counts at the first visit after COVID-19 infection compared with the last visit before infection (A). Platelet counts at the 3 months after COVID-19 infection compared with the last visit before infection (B). Platelet counts at the 6 months after COVID-19 infection compared with the last visit before infection (C). Platelet counts at the first visit, at the 3 months and 6 months after COVID-19 infection which compared with each other (D).