bloodjourГематология и трансфузиологияRussian journal of hematology and transfusiology0234-57302411-3042ООО Издательский дом «Практика»10.35754/0234-5730-2021-66-1-20-36bloodjour-269Research ArticleCOVID-19 В ГЕМАТОЛОГИИCOVID-19 IN HEMATOLOGYОсобенности терапии иммунной тромбоцитопении в условиях новой коронавирусной инфекции (COVID-19)Management of immune thrombocytopenia during COVID-19 pandemichttps://orcid.org/0000-0002-8129-8114СемочкинС. В.SemochkinS. V.

Семочкин Сергей Вячеславович, доктор медицинских наук, главный научный сотрудник отделения высокодозной химиотерапии с блоком трансплантации костного мозга, МНИОИ им.  П.  А.  Герцена  — филиал ФГБУ «НМИЦ радиологии» Министерства здравоохранения Российской Федерации; профессор кафедры онкологии, гематологии и  лучевой терапии, ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н. И. Пирогова» Министерства здравоохранения Российской Федерации; врач-гематолог, ГБУЗ «Городская клиническая больница № 52» Департамента здравоохранения г. Москвы

117997, Москва,

125284, Москва,

123182, Москва

Sergey V. Semochkin, Dr. Sci. (Med.), Principal Researcher, Department of High-Dose Chemotherapy with Bone Marrow Transplantation Unit, Hertzen Moscow Oncology Research Center; Prof., Chair of Oncology, Haematology and Radiation Therapy, Pirogov Russian National Research Medical University; Physician (haematology), City Clinical Hospital No. 52

117997, Moscow,

125284, Moscow,

123182, Moscow

semochkin_sv@rsmu.ruhttps://orcid.org/0000-0001-7493-0030МитинаТ. А.MitinaT. A.

Митина Татьяна Алексеевна, доктор медицинских наук, профессор, руководитель отделения клинической гематологии и иммунотерапии

129110, Москва

Tatiana A. Mitina, Dr. Sci. (Med.), Prof., Head of the Department of Clinical Haematology and Immunotherapy

129110, Moscow

mi_69@inbox.ruhttps://orcid.org/0000-0001-7308-0927ТолстыхТ. Н.TolstykhT. N.

Толстых Татьяна Николаевна, кандидат медицинских наук, врач-гематолог

123182, Москва

Tatiana N. Tolstykh, Cand. Sci. (Med.), Physician (haematology)

123182, Moscow

t.perestoronina@mail.ruФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н. И. Пирогова» Министерства здравоохранения Российской Федерации; МНИОИ им. П. А. Герцена — филиал ФГБУ «НМИЦ радиологии» Министерства здравоохранения Российской Федерации; ГБУЗ «Городская клиническая больница № 52» Департамента здравоохранения г. МосквыРоссияN. I. Pirogov Russian National Research Medical University; P. Hertsen Moscow Oncology Research Center — Branch of the National Medical Research Radiological Centre; City Clinical Hospital N 52Russian FederationГБУЗ МО МОНИКИ им. М. Ф. ВладимирскогоРоссияVladimirsky Moscow Regional Research and Clinical Institute (MONIKI)Russian FederationГБУЗ «Городская клиническая больница № 52» Департамента здравоохранения г. МосквыРоссияCity Clinical Hospital N 52Russian Federation2021180520216612036Copyright © Семочкин С.В., Митина Т.А., Толстых Т.Н., 20212021Семочкин С.В., Митина Т.А., Толстых Т.Н.Semochkin S.V., Mitina T.A., Tolstykh T.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.htjournal.ru/jour/article/view/269Введение

Введение. Для специалистов здравоохранения и  больных, страдающих гематологическими заболеваниями, пандемия COVID-19 принесла целый ряд проблем в  плане диагностики, лечения, наблюдения, необходимости социального дистанцирования и других ограничений.

Цель  — обсуждение терапии иммунной тромбоцитопении (ИТП) в  период пандемии COVID‐19 в  соответствии с собственным опытом и рекомендациями, предложенными отечественными и международными профессиональными медицинскими сообществами.

Основные сведения

Основные сведения. Для больных ИТП без признаков COVID-19 методом выбора является стандартное лечение, такое как применение глюкокортикостероидных гормонов (ГКС) и внутривенного иммуноглобулина. Ранний перевод на терапию агонистами рецепторов тромбопоэтина (рТПО) представляется оптимальным подходом, который уменьшает риск инфицирования за счет отказа от ГКС и обеспечивает существенный процент стойких ремиссий, не требующих поддерживающего лечения. Больным с сочетанием ИТП и COVID-19 следует рассмотреть назначение преднизолона в дозе 20 мг/сут, если нет признаков активного кровотечения. При отсутствии ответа через 3–5 дней доза преднизолона может быть увеличена до 1 мг/кг/сут. Больным ИТП, госпитализированным по поводу COVID-19, необходимо начинать тромбопрофилактику низкомолекулярными гепаринами, как только количество тромбоцитов будет ≥  30  ×  109 /л. Больным хронической ИТП следует продолжать обычное лечение, соблюдая стандартные методы защиты от SARS-CoV-2 и меры социального дистанцирования. В качестве иллюстрации представлены три отличающихся между собой клинических наблюдения тромбоцитопении у  больных с  COVID-19, обсуждаются вопросы дифференциальной диагностики и терапии ИТП. Двое больных получали лечение ГКС и агонистами рТПО (ромиплостим, элтромбопаг), а третий достиг «тромбоцитарного ответа» в результате терапии только ГКС. У всех больных получен хороший клинический и биологический ответ. Обсуждаются вопросы вакцинации против SARSCoV-2.

Introduction

Introduction. The COVID-19 pandemic has challenged health professionals and patients suffering from haematological diseases with embarrassed diagnosis, treatment, surveillance, social distancing and other constraints.

Aim — addressing therapy for immune thrombocytopenia (ITP) during the COVID-19 pandemic in the light of own experience, as well as national and international professional medical community guidelines.

Main findings

Main findings. A standard choice in COVID-19-negative ITP patients are conventional, e.g., glucocorticosteroid (GCS) and intravenous immunoglobulin therapies. An early transfer to thrombopoietin receptor agonists (rTPO) appears optimal as reducing the infection risk in GCS withdrawal and significantly improving the stable remission rate without supportive treatment. Combined ITP–COVID-19 patients should consider a prednisolone treatment of 20 mg/day, provided an absent active bleeding. The dose may increase to 1 mg/kg/day in no response after 3–5 days. ITP patients admitted for COVID-19 should start weight‐based LMWH thromboprophylaxis upon attaining a platelet count of ≥ 30 × 109 /L. Chronic ITP patients should carry on usual treatment with standard SARS-CoV-2 preventive and social distancing measures. We exemplify three contrasting clinical cases of COVID-19-comorbid thrombocytopenia and discuss the ITP differential diagnosis and therapy. Two patients received GCSs and rTPO agonists (romiplostim, eltrombopag), while GCSs alone provided for platelet response in the third case. All patients showed a good clinical and biological response. Issues in SARS-CoV-2 vaccination are discussed.

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The authors declare that there are no conflicts of interest present.