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COVID-19 vaccination associated severe immune thrombocytopenia
Syed Raza Ali Shah1,2, Sherpa Dolkar3, Jacob Mathew4
1Departments of Hospital Medicine, St. Michael Medical Center, Virginia Mason Franciscan Health, Silverdale, WA, USA. syedrashah@gmail.com.
Insights
Three individuals developed severe immune thrombocytopenia (ITP) after receiving COVID-19 vaccines. This report highlights potential vaccine-induced ITP and the need for management guidelines.
Area of Science:
- Immunology
- Vaccinology
- Hematology
Background:
- Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused the COVID-19 pandemic, leading to millions of deaths globally.
- The U.S. Food and Drug Administration (FDA) has issued emergency use authorizations for several COVID-19 vaccines.
- Immune thrombocytopenia (ITP) is a bleeding disorder characterized by low platelet counts.
Purpose of the Study:
- To report three cases of severe immune thrombocytopenia (ITP) following COVID-19 vaccination.
- To describe the clinical course and management of these vaccine-induced ITP cases.
- To underscore the need for further research and management guidelines for vaccine-associated ITP.
Main Methods:
- Case report methodology detailing three distinct patient cases.
- Review of patient medical history, vaccination status, and presenting symptoms.
- Laboratory tests to assess platelet counts and rule out other causes of thrombocytopenia.
- Description of treatment protocols, including intravenous immunoglobulin (IVIG) and corticosteroids.
Main Results:
- Three patients developed severe ITP (platelet counts as low as 2 × 10^9/L) within days of receiving either the Pfizer-BioNTech or Johnson & Johnson COVID-19 vaccine.
- All patients received treatment with IVIG and/or oral dexamethasone, resulting in improved platelet counts.
- No prior history of thrombocytopenia was reported in two cases, while one patient had chronic ITP in remission.
Conclusions:
- COVID-19 vaccination has been associated with the recent acknowledgment of vaccine-induced ITP.
- Limited data and few reported cases highlight the absence of established management guidelines for vaccine-induced ITP.
- Further investigation is warranted to guide the management of ITP following COVID-19 vaccination, especially in individuals with predisposing conditions.
Background:
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 has emerged as a deadliest global pandemic after its identification in December 2019 in Wuhan, China resulting in more than three million deaths worldwide. Recently FDA issued emergency authorization for three vaccines for prevention of COVID-19. Here in, we report three cases of severe immune thrombocytopenia (ITP) following COVID-19 vaccination and their clinical course.
Case Presentations:
Case #1: 53 year old male with past medical history of Crohn's disease was admitted for myalgias and diffuse petechial rash 8 days after receiving second dose of Pfizer-BioNTech COVID-19 vaccine. A complete blood test showed a platelet count of 2 × 109/L. Patient did not have a prior history of thrombocytopenia and other causes of thrombocytopenia were ruled out by history and pertinent lab data. He received two doses of intravenous immunoglobulin and oral dexamethasone for 4 days resulting in normalization of platelet counts. Case #2: 67 year male with past medical history of chronic ITP in remission was admitted for melena 2 days after receiving his first dose of Pfizer-BioNTech COVID-19 vaccine. A complete blood test showed a platelet count of 2 × 109/L. Physical exam showed generalized petechiae. There was no history of recent flares of ITP and patient had normal platelet counts following his splenectomy 4 years ago. He received two doses of IVIG and oral dexamethasone for 4 days with gradual improvement in platelet counts. Case #3: 59 year old female with past medical history of chronic ITP secondary to SLE was admitted for bloody diarrhea 2 days after receiving her first dose of Johnson and Johnson COVID-19 vaccine. Physical exam was unremarkable. A complete blood test showed platelet count of 64 × 109/L which dropped to 27 × 109/L during hospital course. She received oral dexamethasone for 4 days with improvement in platelet counts.
Conclusion:
COVID-19 vaccination induced ITP has been recently acknowledged. However, given very few cases and limited data, currently there are no guidelines for management of ITP caused by COVID-19 vaccine as well as vaccination of people with predisposing conditions.
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