Methods and Materials
We conducted a multi-center, retrospective cohort study in the Cleveland
Clinic Enterprise. We included all adult patients (age ≥ 18 years) with
the diagnosis of chronic ITP admitted between March 2020 and November
2020 with COVID-19. Diagnosis of COVID-19 was confirmed using polymerase
chain reaction test (PCR). The patients were identified through a manual
review of the electronic medical records. We excluded patients who were
newly diagnosis with ITP secondary to COVID-19 infection, were not
admitted to the hospital, or tested negative with COVID-19 from the
study. We reviewed patients admitted to both regular medical floor and
Intensive care units. The study was approved by the Institutional Review
Board of the Cleveland Clinic.
ITP relapse was defined as recurrence of bleeding symptoms or drop in
platelet count to < 100 × 109/L after
sustaining remission for three months at least with or without
treatment.8 Partial response to treatment was defined
based on platelet count of >30 x 109/L
and doubling of the baseline value and complete response to treatment
was defined based on a platelet count of >100x
109/L.9
Development of bleeding events like gastrointestinal (GIB), skin,
mucocutaneous, central nervous system (CNS), genitourinary, epistaxis,
hemoptysis, and muscles hematoma were investigated in the setting of
COVID-19 infection. Patients with CNS bleeding or who developed
hemorrhagic shock secondary to bleeding, or required blood transfusion
were considered to have major bleeding events. Modified WHO bleeding
scale was used to assess bleeding events severity.10