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