González-López, Tomás JoséBárez, AbelardoBernardo-Gutiérrez, AngelBernat, SilviaCanaro, MarianaEntrena Ureña, LauraFernández Fuertes, Luis FernandoGuinea de Castro, José MaríaJiménez-Bárcenas, ReyesPascual-Izquierdo, CristinaSánchez González, BlancaJarque, Isidro2023-04-052023-04-052023González-López TJ, Bárez A, Bernardo-Gutiérrez A, Bernat S, Canaro-Hirnyk M, Entrena-Ureña L, Fernández-Fuertes F, Guinea de Castro JM, Jiménez-Bárcenas R, Pascual-Izquierdo C, Sánchez-González B, Jarque I. Recommendations on the management of patients with immune thrombocytopenia (ITP) in the context of SARS-CoV-2 infection and vaccination: Consensus guidelines from a Spanish ITP expert group. Infect Dis Ther. 2023 Feb;12(2):303-15. DOI: 10.1007/s40121-022-00745-22193-6382http://hdl.handle.net/10230/56426Primary immune thrombocytopenia (ITP) is an acquired autoimmune disease with highly variable presentation, characteristics, and clinical course. Thrombocytopenia is a common complication of many viral infections, including SARS-CoV-2. In addition, both de novo ITP and exacerbation of ITP after vaccination against SARS-CoV-2 have been reported. Patients infected with SARS-CoV-2 develop a prothrombotic coagulopathy called COVID-19-associated coagulopathy (CAC). In addition, autoimmune hematological disorders secondary to SARS-CoV-2 infection, mainly ITP and autoimmune hemolytic anemia (AIHA), have been described. Furthermore, SARS-CoV-2 infection has been associated with exacerbation of autoimmune processes, including ITP. In fact, there is evidence of a high relapse rate in patients with preexisting ITP and COVID-19. As for vaccination against SARS-CoV-2, hematological adverse events (HAE) are practically anecdotal. The most common HAE is thrombocytopenia-associated thrombosis syndrome (TTS) linked to vectored virus vaccines. Other HAEs are very rare, but should be considered in patients with previous complement activation disease or autoimmunity. In patients with ITP who are vaccinated against SARS-CoV-2, the main complication is exacerbation of ITP and the bleeding that may result. In fact, this complication occurs in 12% of patients, with splenectomized and refractory patients with more than five lines of previous treatment and platelet counts below 50 × 109/L being the most vulnerable. We conclude that, in general, there is no greater risk of severe SARS-CoV-2 infection in ITP patients than in the general population. Furthermore, no changes are advised in patients with stable ITP, the use of immunosuppressants is discouraged unless there is no other therapeutic option, and patients with ITP are not contraindicated for vaccination against COVID-19.application/pdfeng© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.info:eu-repo/semantics/articlehttp://dx.doi.org/10.1007/s40121-022-00745-2Autoimmune hemolytic anemiaCOVID-19-associated coagulopathyPrimary immune thrombocytopeniaSARS-CoV-2Thrombocytopenia-associated thrombosis syndromeinfo:eu-repo/semantics/openAccess