Relapse treatments and outcomes
Of all patients treated for ITP relapses, three patients (23%) showed complete response after different steroid treatment regimen in the context of COVID-19 therapy, as following: methylprednisolone 40mg twice daily for 10 days, dexamethasone 6mg daily for eight days, and methylprednisolone 60mg daily for ten days. One patient (7.7%) required romiplostim 3mcg/kg for one day in addition to prednisone 5mg for seven days and dexamethasone 6mg for ten days. One patient (7.7%) achieved partial response to dexamethasone 6mg for ten days and so recommended initiating eltrombopag, however, the final decision was not to proceed with eltrombopag because of the concern for hepatotoxicity side effect and platelet count was trending up from the nadir of 17 x109/L. None of our relapsed patients required IVIG. Among patients who were treated conservatively, complete response achieved in 50% (4/8) and partial response achieved in 12.5% (1/8). Of the remaining observed patients, 25% (2/8) of the patients had stable platelet count and only one (7.7%) patient had a progressive decline in platelet count and the patient opted for hospice due to life-limiting illness.
Out of all patients with chronic ITP and COVID-19 infection, seven (23.3%) death events happened. None of the patients died secondary to bleeding complications. The main cause of death in all patients was acute hypoxic respiratory failure. Five (71.4%) out of the total patients who died had ITP relapses.