Immune Thrombocytopenia Secondary to COVID-19: a Systematic Review.
Immune Thrombocytopenia Secondary to COVID-19: a Systematic Review.
复制标题
DOI：
10.1007/s42399-020-00521-8
复制
发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Banerjee M
中科院分区：
文献类型：
--
作者：
Bhattacharjee S;Banerjee M
免疫性血小板减少症，通常被称为免疫性血小板减少性紫癜，已成为新冠肺炎的重要并发症。我们进行了一项系统的回顾，以分析到目前为止文献中描述的45例新发于新冠肺炎的特发性血小板减少性紫杉醇的临床特征和转归。在排除了几个可能导致新冠肺炎患者血小板减少的伴随因素后，综合方法对于诊断新冠肺炎相关性特发性血小板减少性紫杉醇是必不可少的。大多数ITP患者(71%)是老年人(>； ，50岁)，75%的患者有中到重度新冠肺炎。3名患者(7%)属于儿科年龄组。在无症状的新冠肺炎患者中发现特发性肺炎的报告(7%)强调了在这次大流行中对新诊断的特发性肺炎患者进行新冠肺炎检测的必要性，而不管新冠肺炎的症状如何。20%的患者起病于新冠肺炎症状起病3周后，临床痊愈后报告较多。SARS-CoV-2介导的免疫性血小板减少可归因于潜在的免疫失调、SOCS 1的易感性突变以及其他机制，包括分子模仿、隐蔽抗原表达和表位扩散。31%的患者确诊时未见出血表现。危及生命的严重出血并不常见。1例死亡归因于颅内出血。1例诊断为继发性Evans综合征。除1例延迟反应外，对短程糖皮质激素和静脉注射免疫球蛋白的初始反应良好。血小板生成素受体激动剂作为二线药物的使用在少数病例中被注意到，持续时间较短，没有不良反应。在较短的随访期内，发现4例ITP复发。
Immune thrombocytopenia, often known as immune thrombocytopenic purpura (ITP), has emerged as an important complication of COVID-19. A systematic review was done to analyze the clinical profile and outcomes in a total of 45 cases of new-onset ITP in COVID-19 patients described in literature until date. A comprehensive approach is essential for diagnosing COVID-19-associated ITP after excluding several concomitant factors that can cause thrombocytopenia in COVID-19. Majority of ITP cases (71%) were found to be elderly (> 50 years) and 75% cases had moderate-to-severe COVID-19. Three patients (7%) were in the pediatric age group. Reports of ITP in asymptomatic COVID-19 patients (7%) underscore the need for COVID-19 testing in newly diagnosed patients with ITP irrespective of COVID-19 symptoms amid this pandemic. ITP onset occurred in 20% cases 3 weeks after onset of COVID-19 symptoms, with many reports after clinical recovery. SARS-CoV-2-mediated immune thrombocytopenia can be attributed to the underlying immune dysregulation, susceptibility mutations in SOCS 1, and other mechanisms, including molecular mimicry, cryptic antigen expression, and epitope spreading. No bleeding manifestations were reported in 31% cases at diagnosis. Severe life-threatening bleeding was uncommon. One case of mortality was attributed to intracranial hemorrhage. Secondary Evans syndrome was diagnosed in one case. Good initial response to short course of glucocorticoids and intravenous immunoglobulin has been found with the exception of delayed lag response in one case. Thrombopoietin receptor agonist usage as a second-line agent has been noted in few cases for short duration with no adverse events. In the relatively short follow-up period, four relapses of ITP were found.