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Updated: Feb 17, 2026

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SEVERE IMMUNE-MEDIATED THROMBOCYTOPENIA AFTER INTRAVITREAL BEVACIZUMAB INJECTION.

Tianyi Li1, Derek T Witteman2, Eric D Weber3

  • 1Department of Internal Medicine, William Beaumont Army Medical Center, El Paso, TX.

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Severe immune-mediated thrombocytopenia occurred in a patient after receiving intravitreal bevacizumab for macular degeneration. Prompt treatment with immunosuppressants and specialized platelets led to recovery.

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Area of Science:

  • Ophthalmology
  • Immunology
  • Hematology

Background:

  • Intravitreal bevacizumab is a common treatment for neovascular age-related macular degeneration.
  • Immune-mediated adverse events are rare but serious complications of anti-vascular endothelial growth factor therapies.

Observation:

  • A 77-year-old male developed severe thrombocytopenia (platelet count 3 k/μL) after his third intravitreal bevacizumab injection.
  • Bone marrow biopsy showed megakaryocytic hyperplasia, and serum testing revealed antibodies against glycoprotein IV and human leukocyte antigens.

Findings:

  • The patient's thrombocytopenia was refractory to platelet transfusions.
  • Treatment with rituximab, romiplostim, and HLA-matched platelets resulted in slow but complete recovery of platelet counts.

Implications:

  • This case highlights a potential severe immune-mediated adverse effect of intravitreal bevacizumab.
  • Early recognition and aggressive immunosuppressive therapy are crucial for managing this rare complication.