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The evolution of preexisting primary immune thrombocytopenia after COVID-19 onset: A nationally representative, prospective, multicentre, observational study

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Abstract

The symptoms in patients with primary immune thrombocytopenia (ITP) after COVID-19 onset remain largely unclear. The aim of this study was to describe the platelet count fluctuations in ITP patients following the diagnosis of COVID-19. A prospective multicentre observational study was conducted from December 15th, 2022, to January 31st, 2023 in 39 general hospitals across China. Patients with preexisting primary ITP who were newly diagnosed with COVID-19 were enrolled. A total of 1216 ITP patients with newly-diagnosed COVID-19 were enrolled. 375 (30.8%) patients experienced ITP exacerbation within eight weeks after the diagnosis of COVID-19, and most exacerbation (266/375, 70.9%) developed in the first two weeks. Immunosuppressive therapy for ITP and severe/critical COVID-19 infection were independent variables associated with ITP exacerbation. Overall the platelet count had a transient increasing trend, and the platelet peak value occurred at two weeks after COVID-19 infection. Then, the platelet count decreased to the baseline level in the following weeks. The platelet count had a transient increasing trend in ITP patients following the diagnosis of COVID-19. ITP exacerbation only occurred in less than one-third of ITP patients. Nonimmunosuppressive therapy may have an advantage to prevent ITP exacerbation during COVID-19.

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No datasets were generated or analysed during the current study.

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Acknowledgements

The authors thank the participating patients and their families.

The Cooperative ITP Working Group:

Tongfei Meng (ITP home), Sujun Gao (Department of Hematology, The First Hospital of Jilin University, Changchun, Jilin, China), Jianyong Li (Department of Hematology, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province People Hospital), Nanjing, Jiangsu, China), Xiequn Chen (Department of Hematology, Affiliated Hospital of Northwest University & Xian No.3 Hospital, Xian, Shaanxi, China), Mimi Shu (Department of Hematology, Affiliated Hospital of Northwest University & Xian No.3 Hospital, Xian, Shaanxi, China), Shaoyuan Wang (Department of Hematology, Fujian Institute of Hematology, Fujian Medical University Union Hospital, Fuzhou, China), Xiaobing Huang (Department of Hematology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China), Ming Jiang (Center of Hematologic Diseases, The First Affiliated Hospital of Xinjiang Medical University, Urumchi, Xinjiang, China), Hailong Yuan (Center of Hematologic Diseases, The First Affiliated Hospital of Xinjiang Medical University, Urumchi, Xinjiang, China), Yongrong Lai (The First Affiliated Hospital of Guangxi Medical University, Guilin, China), Peng Cheng (The First Affiliated Hospital of Guangxi Medical University, Guilin, China), Hu Zhou (Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Henan Institute of Hematology, Zhengzhou 450008, Henan, China), Fei Li (Department of Hematology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China), Ruibin Huang (Department of Hematology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China), Zhongxing Jiang (Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China), Fang Wang (Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China), Liping Ma (Department of Hematology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China), Liping Su (Shanxi Province Cancer Hospital/ Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Shanxi, China), Jishi Wang (Guizhou Province Hematopoietic Stem Cell Transplantation Center, Key Laboratory of Hematological Disease Diagnostic & Treat Centre of Guizhou, Department of Hematology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China), Peng Zhao (Guizhou Province Hematopoietic Stem Cell Transplantation Center, Key Laboratory of Hematological Disease Diagnostic & Treat Centre of Guizhou Province, Department of Hematology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China), Jianping Shen (Department of Hematology, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Hangzhou, China), Lihong Li (Beijing Tsinghua Changgung Hospital, Beijing, China), Peng Liu (Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China), Yunfeng Cheng (Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China), Qifa Liu (Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China), Jieyu Ye (Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China), Ting Niu (Department of Hematology, Institute of Hematology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China), Hebing Zhou (Department of Hematology, Beijing Luhe Hospital, Capital Medical University, Beijing, China), Xi Zhang (Medical Center of Hematology, Xinqiao Hospital, State Key Laboratory of Trauma, Burn and Combined Injury, Army Medical University, Chongqing, 400037, China), Liangming Ma (Department of Hematology, Shanxi Bethune Hospital of Shanxi Medical University, Taiyuan, Shanxi, China), Yajing Xu (Department of Hematology, Xiangya Hospital, Central South University, Changsha, China), Jie Peng (Department of Hematology, Xiangya Hospital, Central South University, Changsha, China), Hui Liu (Department of Hematology, Beijing Hospital, Beijing, China), Ru Feng (Department of Hematology, Beijing Hospital, Beijing, China), Zhao Wang (Department of Hematology, Beijing Friendship Hospital, Capital Medical University, Beijing, China), Yanqiu Han (The affiliated hospital of Inner Mongolia Medical University, Inner Mongolia, China), Xin Li (Department of Hematology, the Third Xiangya Hospital, Central South University, Changsha, Hunan, China), Xin Du (Department of Hematology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China), Yi Liu (Senior Department of Hematology, the Fifth Medical Center of PLA General Hospital, Beijing, China), Feng Gao (North China university of science and technology affiliated hospital, Hebei, China), Zhen Cai (Department of Hematology, First Affiliated Hospital of Zhejiang Medical University, Hangzhou, China), Zhenling Li (China-Japan Friendship Hospital, Beijing, China), Yuying Li (Department of Hematology, The First Hospital of Jilin University, Changchun, Jilin, China), Peng Hu (Department of Hematology, The First People’s Hospital of Yunnan Province, Kunming, China), Ruinan Lu (Department of Hematology, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province People Hospital), Nanjing, Jiangsu, China), Yan Wang (Department of Hematology, Affiliated Hospital of Northwest University & Xian No.3 Hospital, Xian, Shaanxi, China), Meijuan Huang (Department of Hematology, Fujian Institute of Hematology, Fujian Medical University Union Hospital, Fuzhou, China), Jiawen Huang (Department of Hematology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China), Yun Li (Department of Hematology, Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China), Wenhua Zhou (Department of Hematology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China), Shixuan Wang (Department of Hematology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China), Ran Wang (Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China), Guoyang Zhang (Department of Hematology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China), Jing Ning (The General Hospital of Ningxia Medical University, Lan Zhou, Ningxia, China), Li Ma (Shanxi Province Cancer Hospital/ Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Shanxi, China), Liqiang Wu (Department of Hematology, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Hangzhou, China), Fan Yu (Beijing Tsinghua Changgung Hospital, Beijing, China), Xiang Liu (Department of Hematology, Institute of Hematology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China), Yuanyuan Zhang (Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Henan Institute of Hematology, Zhengzhou 450008, Henan, China), Yong Zhang (Department of Hematology, Beijing Luhe Hospital, Capital Medical University, Beijing, China), Xiaorui Wang (Department of Hematology, Qinghai Provincial People’s Hospital, Qinghai, China), Yimei Feng (Medical Center of Hematology, Xinqiao Hospital, State Key Laboratory of Trauma, Burn and Combined Injury, Army Medical University, Chongqing, 400037, China), Yanyan Niu (Department of Hematology, Shanxi Bethune Hospital of Shanxi Medical University, Taiyuan, Shanxi, China), Gaochao Zhang (Department of Hematology, Beijing Friendship Hospital, Capital Medical University, Beijing, China), Jing Zhang (The affiliated hospital of Inner Mongolia Medical University, Inner Mongolia, China), Ruiheng Luo (Department of Hematology, the Third Xiangya Hospital, Central South University, Changsha, Hunan, China), Chengwei Luo (Department of Hematology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China), Li Li (Department of Hematology, the Sixth Medical Center of PLA General Hospital, Beijing, China), Shuqing Feng (North China university of science and technology affiliated hospital, Hebei, China), Jing Chen (Department of Hematology, First Affiliated Hospital of Zhejiang Medical University, Hangzhou, China), Yang Li (China-Japan Friendship Hospital, Beijing, China).

Funding

This work was supported by National Key Research and Development Program of China (No. 2021YFC2500304), Key Program of National Natural Science Foundation of China (No. 82230004), National Natural Science Foundation of China (No. 81970113), Beijing Natural Science Foundation (No. 7232188) and the Capital Health Research and Development of Special (No. 2022–1-4082). The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the manuscript.

Author information

Author notes

  1. Haixia Fu, Xuan Cai, Lijuan Cui, Weixia Nong and Wenqian Li contributed equally to the study and share co-first authorship.

Authors and Affiliations

  1. Peking University People’s Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, 100044, China

    Haixia Fu, Xuan Cai, Qiusha Huang, Zhuoyu An, Yejun Wu, Xiaojun Huang & Xiaohui Zhang

  2. General Hospital of Ningxia Medical University, Lan Zhou, Ningxia, China

    Lijuan Cui

  3. Department of Hematology, First Affiliated Hospital, School of Medicine, Shihezi University, Xinjiang, China

    Weixia Nong

  4. Department of Hematology, Qinghai Provincial People’s Hospital, Xining, Qinghai, China

    Wenqian Li

  5. Institute of Hematology, Union Hospital, Tonggji Medical Colloege, Huazhong University of Science and Technology, Wuhan, China

    Heng Mei

  6. Department of Hematology, The First People’s Hospital of Yunnan Province, Kunming, China

    Tonghua Yang

  7. Department of Hematology, Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China

    Han Yue

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  1. Haixia Fu
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Consortia

on behalf of the Collaborative ITP Working Group

  • Tongfei Meng
  • , Sujun Gao
  • , Jianyong Li
  • , Xiequn Chen
  • , Mimi Shu
  • , Shaoyuan Wang
  • , Xiaobing Huang
  • , Ming Jiang
  • , Hailong Yuan
  • , Yongrong Lai
  • , Peng Cheng
  • , Hu Zhou
  • , Fei Li
  • , Ruibin Huang
  • , Zhongxing Jiang
  • , Fang Wang
  • , Liping Ma
  • , Liping Su
  • , Jishi Wang
  • , Peng Zhao
  • , Jianping Shen
  • , Lihong Li
  • , Peng Liu
  • , Yunfeng Cheng
  • , Qifa Liu
  • , Jieyu Ye
  • , Ting Niu
  • , Hebing Zhou
  • , Xi Zhang
  • , Liangming Ma
  • , Yajing Xu
  • , Jie Peng
  • , Hui Liu
  • , Ru Feng
  • , Zhao Wang
  • , Yanqiu Han
  • , Xin Li
  • , Xin Du
  • , Yi Liu
  • , Feng Gao
  • , Zhen Cai
  • , Zhenling Li
  • , Yuying Li
  • , Peng Hu
  • , Ruinan Lu
  • , Yan Wang
  • , Meijuan Huang
  • , Jiawen Huang
  • , Yun Li
  • , Wenhua Zhou
  • , Shixuan Wang
  • , Ran Wang
  • , Guoyang Zhang
  • , Jing Ning
  • , Li Ma
  • , Liqiang Wu
  • , Fan Yu
  • , Xiang Liu
  • , Yuanyuan Zhang
  • , Yong Zhang
  • , Xiaorui Wang
  • , Yimei Feng
  • , Yanyan Niu
  • , Gaochao Zhang
  • , Jing Zhang
  • , Ruiheng Luo
  • , Chengwei Luo
  • , Li Li
  • , Shuqing Feng
  • , Jing Chen
  •  & Yang Li

Contributions

XHZ, HXF, XC, LJC, WXN, WQL and HM contributed to the designed, conceived and supervised the study. All authors collected the data. HXF, THY, QSH and ZYA contributed to data analysis and data interpretation, and performed statistical analysis. HXF, QSH, HY, ZYA and YJW wrote the manuscript. XJH and XHZ revised the manuscript. All authors had full access to all the data in the study and approved the final version of the manuscript.

Corresponding author

Correspondence to Xiaohui Zhang.

Ethics declarations

Ethics approval and consent to participate

The study was was approved by each centre’s ethics committee or institutional review board. All participants provided informed written consent, and the study was conducted in accordance with the Declaration of Helsinki.

Competing interests

The authors declare no competing interests.

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Fu, H., Cai, X., Cui, L. et al. The evolution of preexisting primary immune thrombocytopenia after COVID-19 onset: A nationally representative, prospective, multicentre, observational study. Ann Hematol 103, 1549–1559 (2024). https://doi.org/10.1007/s00277-024-05720-0

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