What to Know About Immune Thrombocytopenia and COVID-19

Immune thrombocytopenia (ITP) is a condition in which the immune system abnormally destroys platelets. Platelets are the type of cell in the blood that help the blood clot and heal blood vessel walls if they are damaged, to prevent bleeding.

In ITP, the immune system destroys platelets, causing their numbers to decrease and increasing the risk of bleeding. At this time, it does not appear that having a diagnosis of ITP increases someone’s chance of getting infected with COVID-19, and it does not increase their risk for more severe infection. Research is ongoing as the pandemic continues.

Immune Thrombocytopenia and COVID-19 Risk

Research available at this time does not show that having a previous history of ITP causes an increased risk of becoming infected with COVID-19. However, as ITP can develop as a result of an immune system reaction, there have been reports of people developing ITP during a COVID-19 infection.

Complications of Immune Thrombocytopenia and COVID-19

Thrombocytopenia can be a common finding in someone infected with COVID-19, even if they don’t have a history of ITP. In some cases, it can be severe and lead to significant, even potentially fatal, bleeding.

Risk of Blood Clots

Those infected with COVID-19 carry an increased risk of developing blood clots. Generally, this risk is managed with the use of blood-thinning medications such as heparin or enoxaparin.

However, in people living with ITP and having low platelet counts, the use of blood-thinning medications may need to be avoided. This leads to the potential increased risk of clotting.

Immune Thrombocytopenia Treatments and COVID-19

Treatments for ITP may continue to be the same if someone is also experiencing a COVID-19 infection. 

Observation

Some people living with ITP are under routine observation of platelet counts through periodic blood tests. The frequency in which someone requires blood tests is dependent upon each person, but if one’s risk of developing COVID-19 infection is high and their platelet counts have been stable, they may potentially delay routine blood testing.

Home blood testing may also be a possibility for those at higher risk of developing COVID-19 due to other factors. This should be discussed with the healthcare team that is monitoring ITP to see if these options are available.

Symptoms of ITP that should be reported to the healthcare team include:

• Bruising
• Blood blisters in mouth
• Petechiae: small pinpoint red spots on the skin
• Firm, bruised lump under the skin
• Nosebleeds
• Blood seen in the stool or urine
• Significant fatigue

Immunosupressive Medications

Multiple medications can be given to suppress the immune system of someone living with ITP. These medications stop the immune system from destroying platelets which can lead to bleeding. If someone with ITP is on medications and does not have an active COVID-19 infection, stopping these medications is not recommended at this time.

One of the medications typically used to manage chronic ITP is steroids. These work by suppressing the immune system’s function and stopping platelet destruction. Current data suggests that low-dose use of these medications to treat ITP should still continue despite the potential for increased infection risk. For people on higher dosages, other medications may be prescribed to allow for lowering the steroid dose. 

Infusions such as Rituxan can be given to treat ITP. This medication works by preventing the immune system from destroying platelets.

However, there is some increased risk of infection and decreased immune building response after infection or immunization up to six months after getting the infusion. There currently isn’t data available to show that this increases the risk of COVID-19 or worsens the infection if contracted.

Other Medications for Immune Thrombocytopenia

In addition to immunosuppressive medications, there are treatments for ITP that do not have any effect on the immune system. Oral medications can be prescribed to increase bone marrow production of platelets, and it is safe to continue these at home.

Other treatments including immune globulin infusions and a bone marrow-stimulating subcutaneous injection require administration in a hospital or infusion center. The risks of coming to an infusion center can be weighed against stopping these medications or switching to another agent to decrease potential for COVID-19 exposure. 

Surgery

Surgical procedures, such as splenectomy, may have initially been postponed at the beginning of the COVID-19 pandemic out of fear of decreased healthcare resources and to decrease the risk of the spread of the outbreak.

A splenectomy is done to decrease platelet destruction. However, as long as it is safe to do, these surgeries are being done again. 

If someone with ITP had a splenectomy previously, they may be at higher risk of bacterial infections and should make sure they are up to date on current immunizations to prevent infection and decrease the risk of hospitalization during the pandemic.

It does not appear that those with previous splenectomy are at a higher risk of developing COVID-19.

Frequently Asked Questions

Is COVID-19 more dangerous for people with ITP?

Research does not show that people with ITP are at a higher risk of contracting COVID-19. Also, they do not seem to be having more serious symptoms from the infection. 

Is it safe for people living with ITP to get the COVID-19 vaccine?

This is a question that should be discussed with the healthcare team treating the ITP, as historically there have been cases where platelet counts have decreased following a viral infection or immunization.

However, the benefit of the vaccine likely outweighs the risk of decreased platelets, with the possible exception of those with unstable platelet counts.

Does ITP treatment need to be stopped or changed due to the COVID-19 pandemic?

If you’re under routine observation of platelet counts and they have been stable, your healthcare provider may feel comfortable extending the time period in between checking blood tests.

If you’re on any type of treatment for ITP, it should be discussed with your healthcare provider to see if these treatments increase your risk of exposure to COVID-19 and to develop an alternate treatment plan if you’re not comfortable going to their office.

How to Stay Safe

Preventing the spread of COVID-19 continues to remain incredibly important. The following recommendations should still be in place, even if vaccinated against the virus:

• If you are at increased risk of severe COVID-19, consider wearing a mask in crowds and keeping a social distance of at least six feet from those who do not live in your household. This is particularly recommended when the spread of the virus is high in your community.
• Cover sneezes or coughs with a tissue or elbow.
• Get a COVID-19 vaccine and recommended boosters if ok with your healthcare provider.

A Word From Verywell

So much continues to be unknown about the COVID-19 infection and its impact on other health conditions such as ITP. However, with what is currently known at this time, having ITP doesn’t seem to increase the risk of getting COVID-19 or the severity of the infection.

Following risk-reducing behaviors such as mask wearing and social distancing continues to be important. Getting vaccinated against COVID-19 should be strongly considered as long as it is ok with your healthcare provider. 

The information in this article is current as of the date listed. As new research becomes available, we’ll update this article. For the latest on COVID-19, visit our coronavirus news page.