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Zhan XY, Chen H, Kong H, Meng T, Ye J, Liu Y, Ng MHL, Li L, Zhang Y, Huang J, Peng Q, Chen C, He Y, Yang M. Platelet dropping, bleeding and new treatment requirements in ITP patients after inactivated COVID-19 vaccination. Immunol Lett 2023; 264:56-63. [PMID: 38006954 DOI: 10.1016/j.imlet.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/14/2023] [Accepted: 11/23/2023] [Indexed: 11/27/2023]
Abstract
Significant decreases in platelet counts and ITP relapses have been documented in ITP patients receiving COVID-19 mRNA vaccines; however, the effect of the inactivated COVID-19 vaccine on ITP patients remains unclear. The present study aimed to investigate the impact of inactivated COVID-19 vaccines on ITP patients, with a focus on platelet dropping events, bleeding events/scores, and the requirement of a new round of treatment. A total of 118 ITP patients, with 97 chronic ITP and 21 persistent ITP, who received inactivated COVID-19 immunization were investigated retrospectively. Following vaccination (within 1 month), ITP patients reported platelet dropping (31.36 %), new bleeding events (22.88 %), increases in bleeding scores (23.73 %), and new treatment requirements (22.03 %). Among them, persistent ITP patients with disease duration of 3-12 months had higher ratios of the above adverse events (71.43 %, 57.14 %, 61.90 % and 71.43 %, respectively) than chronic ITP patients with duration > 1 year (22.68 %, 15.46 %, 15.46 % and 11.34 %, respectively); patients' disease duration was negatively correlated with platelet dropping events and new treatment requirements. Furthermore, logistic regression analysis also supported the above findings, revealing that persistent ITP patients had 9.40-9.70, 7.24-10.08, and 27.17-28.51 times incidence of having platelet dropping events, new bleeding events, and new treatment requirements after vaccination, respectively, when compared to chronic ITP patients. In conclusion, the present study demonstrates that after receiving inactivated COVID-19 vaccines, ITP patients may experience platelet dropping, which may lead to new bleeding events and the requirement of a new round of treatment for ITP recurrence. As a result, platelet level monitoring is crucial for ITP patients during the vaccination, especially those with persistent ITP.
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Affiliation(s)
- Xiao-Yong Zhan
- The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Hui Chen
- The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.
| | - Huimin Kong
- The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | | | - Jieyu Ye
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yong Liu
- The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Margaret H L Ng
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China
| | - Liang Li
- The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Yuming Zhang
- Department of Hematology, Hematology Research Institute, Affiliated Hospital of Guangdong Medical University (GDMU), Zhanjiang, China
| | - Jinqi Huang
- Department of Hematology, Hematology Research Institute, Affiliated Hospital of Guangdong Medical University (GDMU), Zhanjiang, China
| | - Qiang Peng
- The Third Affiliated Hospital, Shenzhen University, Shenzhen, China
| | - Chun Chen
- The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.
| | - Yulong He
- The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.
| | - Mo Yang
- The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China; Department of Hematology, Hematology Research Institute, Affiliated Hospital of Guangdong Medical University (GDMU), Zhanjiang, China.
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2
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Mingot-Castellano ME, Canaro Hirnyk M, Sánchez-González B, Álvarez-Román MT, Bárez-García A, Bernardo-Gutiérrez Á, Bernat-Pablo S, Bolaños-Calderón E, Butta-Coll N, Caballero-Navarro G, Caparrós-Miranda IS, Entrena-Ureña L, Fernández-Fuertes LF, García-Frade LJ, Gómez del Castillo MDC, González-López TJ, Grande-García C, Guinea de Castro JM, Jarque-Ramos I, Jiménez-Bárcenas R, López-Ansoar E, Martínez-Carballeira D, Martínez-Robles V, Monteagudo-Montesinos E, Páramo-Fernández JA, Perera-Álvarez MDM, Soto-Ortega I, Valcárcel-Ferreiras D, Pascual-Izquierdo C. Recommendations for the Clinical Approach to Immune Thrombocytopenia: Spanish ITP Working Group (GEPTI). J Clin Med 2023; 12:6422. [PMID: 37892566 PMCID: PMC10607106 DOI: 10.3390/jcm12206422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/25/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023] Open
Abstract
Primary immune thrombocytopenia (ITP) is a complex autoimmune disease whose hallmark is a deregulation of cellular and humoral immunity leading to increased destruction and reduced production of platelets. The heterogeneity of presentation and clinical course hampers personalized approaches for diagnosis and management. In 2021, the Spanish ITP Group (GEPTI) of the Spanish Society of Hematology and Hemotherapy (SEHH) updated a consensus document that had been launched in 2011. The updated guidelines have been the reference for the diagnosis and management of primary ITP in Spain ever since. Nevertheless, the emergence of new tools and strategies makes it advisable to review them again. For this reason, we have updated the main recommendations appropriately. Our aim is to provide a practical tool to facilitate the integral management of all aspects of primary ITP management.
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Affiliation(s)
- María Eva Mingot-Castellano
- Hematology Department, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, 41013 Sevilla, Spain
| | | | | | - María Teresa Álvarez-Román
- Hematology Department, Hospital Universitario La Paz-IdiPAZ, Universidad Autónoma de Madrid, 28046 Madrid, Spain;
| | | | - Ángel Bernardo-Gutiérrez
- Hematology Department, Hospital Central de Asturias, 33011 Oviedo, Spain; (Á.B.-G.); (D.M.-C.); (I.S.-O.)
| | - Silvia Bernat-Pablo
- Hematology Department, Hospital Universitario de la Plana, 12540 Villarreal, Spain;
| | | | - Nora Butta-Coll
- Hematology Department, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), 28046 Madrid, Spain;
| | | | | | - Laura Entrena-Ureña
- Hematology Department, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain;
| | - Luis Fernando Fernández-Fuertes
- Hematology Department, Complejo Hospitalario Universitario Insular Materno-Infantil, 35016 Las Palmas de Gran Canaria, Spain;
| | - Luis Javier García-Frade
- Hematology Department, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León, 47012 Valladolid, Spain;
| | | | | | | | | | - Isidro Jarque-Ramos
- Hematology Department, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain;
| | | | - Elsa López-Ansoar
- Hematology Department, Complejo Hospitalario Universitario de Vigo, 36312 Vigo, Spain;
| | | | | | | | | | - María del Mar Perera-Álvarez
- Hematology Department, Hospital Universitario de Gran Canaria Doctor Negrín, 35010 Las Palmas de Gran Canaria, Spain;
| | - Inmaculada Soto-Ortega
- Hematology Department, Hospital Central de Asturias, 33011 Oviedo, Spain; (Á.B.-G.); (D.M.-C.); (I.S.-O.)
| | - David Valcárcel-Ferreiras
- Hematology Department, Vall d’Hebron Instituto de Oncología (VHIO), Universitat Autònoma de Barcelona, 08035 Barcelona, Spain;
| | - Cristina Pascual-Izquierdo
- Hematology Department, Hospital General Universitario Gregorio Marañón (HGUGM) Madrid, Instituto de Investigación Gregorio Marañón, 28007 Madrid, Spain;
- Spanish Immune Thrombocytopenia Group, 28040 Madrid, Spain
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3
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Chaudhary MH, Yennam AK, Bojanki NLSVA, Dela Cruz ANG, Chaudhary NK, Kinha H, Annepu YR. Autoimmune Hemolytic Anemia Secondary to COVID-19 Vaccine: A Case Report. Cureus 2023; 15:e46678. [PMID: 37942375 PMCID: PMC10628599 DOI: 10.7759/cureus.46678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2023] [Indexed: 11/10/2023] Open
Abstract
Autoimmune hemolytic anemia (AIHA) is an acquired hemolysis caused by one's immune system targeting red blood cell surface antigens, resulting in a shortening of the normal red-cell lifespan of 120 days. In this case report, we present an unusual case of a middle-aged woman with no known autoimmune diseases. After ruling out all other possible etiologies, she was later diagnosed with AIHA about two months after receiving her first dose of the Oxford-AstraZeneca COVID-19 vaccine (COVISHIELD). We discuss the possible underlying cause, the COVID-19 vaccine, for the precipitation of AIHA. The importance of identifying rare adverse events that could occur during mass vaccination is highlighted in this case. The patient was treated with oral steroids and received three blood transfusions. She was discharged after 21 days from the hospital and followed up after six months with no relapse.
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Affiliation(s)
| | | | | | | | - Nirali K Chaudhary
- General Medicine, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
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4
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Asiimwe E, Kahlon KS. Acute Immune Thrombocytopenia Following Influenza Vaccination in a Patient With Untreated Helicobacter pylori Infection. Cureus 2023; 15:e43946. [PMID: 37746396 PMCID: PMC10513953 DOI: 10.7759/cureus.43946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/26/2023] Open
Abstract
A 70-year-old man with previously normal comprehensive blood counts (CBCs) was referred to our hospital for acute thrombocytopenia. Following a negative workup for secondary causes, we diagnosed immune thrombocytopenia (ITP). Aside from the influenza vaccine administered six days before presentation, there was no discernable precipitant on history. His only risk factor for ITP was untreated Helicobacter pylori diagnosed over two months prior. With treatment, the patient's platelets normalized within three days. ITP following influenza vaccination has been documented in the literature and reported to regulatory bodies. Our case indicates that individuals with untreated H. pylori infection might be particularly vulnerable to such occurrences.
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Affiliation(s)
- Edgar Asiimwe
- Internal Medicine, University of California Los Angeles, Los Angeles, USA
| | - Kanwarpal S Kahlon
- Hematology and Oncology, University of California Los Angeles, Los Angeles, USA
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5
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Claaß LV, Mayr P, Paschold L, Weber T, Terziev D, Jehs B, Brill R, Dober J, Märkl B, Wickenhauser C, Czapiewski P, Trepel M, Claus R, Binder M. No association of malignant B-cell non-Hodgkin lymphomas with ipsilateral SARS-CoV-2 vaccination. Cancer Med 2023; 12:9313-9321. [PMID: 36775947 PMCID: PMC10166887 DOI: 10.1002/cam4.5687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 01/10/2023] [Accepted: 02/01/2023] [Indexed: 02/14/2023] Open
Abstract
PURPOSE SARS-CoV-2 vaccines cause acute ipsilateral lymph node swelling in an important proportion of vaccines. Thus far, no malignant lymphadenopathies have been reported in temporal context to vaccination in the ipsilateral draining lymph node areas. EXPERIMENTAL DESIGN Prompted by two cases with unilateral axillary lymphomas that occurred ipsilaterally to prior SARS-CoV-2 vaccination, we systematically retrieved all B-cell non-Hodgkin lymphomas at two German University Medical Centers diagnosed before and after introduction of SARS-CoV-2 vaccines in Germany. Available lymphoma tissue (n=19) was subjected to next-generation immunosequencing of the IGH locus. Malignant clonotypes were mined in the CoVabDab database and published data sets from 342 uninfected individuals, 55 individuals 28 days after anti-SARS-CoV-2 vaccination and 139 individuals with acute COVID-19 together encompassing over 1 million CDR3 sequences in total. RESULTS Of 313 newly diagnosed cases in the two centers and observation periods, 27 unilateral manifestations in the defined deltoid draining regions were identified. The majority thereof were diffuse large B-cell lymphomas (18 of 27 cases). Eleven unilateral cases were diagnosed in the era of SARS-CoV-2 vaccination and 16 in the control period before introduction of such vaccines. Of the 11 unilateral lymphomas that occurred during the vaccination period, ten had received a SARS-CoV-2 vaccine prior to lymphoma diagnosis. These cases were further evaluated. While left-sided were more frequent than right-sided lymphomas (19 vs 8 cases), no statistically significant association of vaccination site and laterality of the lymphoma manifestation was found. The unilateral lymphomas showed a normal range of B-cell receptors typically found in these lymphoma subtypes with no evidence for anti-SARS-CoV-2 sequences in the malignant clonotype. CONCLUSIONS Together, we found no evidence that the current SARS-CoV-2 vaccines could serve as a trigger for lymphomagenesis in the draining lymph node areas of the deltoid region used for vaccination.
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Affiliation(s)
- Luise Victoria Claaß
- Department of Internal Medicine IV, Oncology/Hematology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Patrick Mayr
- Department of Hematology and Oncology, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Lisa Paschold
- Department of Internal Medicine IV, Oncology/Hematology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Thomas Weber
- Department of Internal Medicine IV, Oncology/Hematology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Denis Terziev
- Department of Internal Medicine IV, Oncology/Hematology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Bertram Jehs
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Richard Brill
- Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Johannes Dober
- Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Bruno Märkl
- General Pathology and Molecular Diagnostics, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Claudia Wickenhauser
- Institute of Pathology, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Piotr Czapiewski
- Department of Pathology, Medical Faculty, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany.,Department of Pathology Dessau Medical Centre, Institute of Pathology, Dessau, Germany
| | - Martin Trepel
- Department of Hematology and Oncology, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Rainer Claus
- General Pathology and Molecular Diagnostics, Medical Faculty, University of Augsburg, Augsburg, Germany.,Comprehensive Cancer Center Augsburg (CCCA), Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Mascha Binder
- Department of Internal Medicine IV, Oncology/Hematology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
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6
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Ali A, Dilibe A, Rai S, Awosika A, Omole AE, Ahmed M, Nwosu S. Cerebral Sinus Thrombosis and Immune Thrombocytopenia Post COVID-19 Vaccination: A Case Report and Narrative Review. Cureus 2023; 15:e34550. [PMID: 36879697 PMCID: PMC9985429 DOI: 10.7759/cureus.34550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2023] [Indexed: 02/05/2023] Open
Abstract
Vaccine-induced immune thrombocytopenia and thrombosis (VITT) following the adenoviral vector COVID-19 vaccine is a rare adverse event. Although the risk of VITT following the COVID-19 vaccine appears to be low, early diagnosis and management can be lifesaving. We present a case of VITT in a young female who presented with persistent headaches and fevers followed by anisocoria and right-sided hemiplegia. Initial imaging was unremarkable, and labs showed thrombocytopenia and elevated d-dimers. Repeat imaging revealed thrombosis in the left transverse and superior sagittal sinuses, and she was diagnosed with VITT. She received combined treatment with intravenous immunoglobulins and systemic anticoagulation, resulting in an increased platelet count and resolution of her neurological symptoms.
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Affiliation(s)
- Azka Ali
- Internal Medicine, Rosalind Franklin University of Medicine and Sciences, Chicago, USA
| | - Arthur Dilibe
- Internal Medicine, East Carolina University Health, Greenville, USA
| | - Shilpa Rai
- Internal Medicine, Isra University, Hyderabad, PAK
| | - Ayoola Awosika
- College of Medicine, University of Illinois, Chicago, USA.,College of Health Sciences and Professions, Ohio University, Athens, USA
| | - Adekunle E Omole
- Anatomical Sciences, American University of Antigua, College of Medicine, Saint John, ATG
| | - Maryam Ahmed
- Internal Medicine, Allied Hospital, Maple Heights, USA
| | - Stella Nwosu
- Hematology and Medical Oncology, Emory University, Atlanta, USA
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7
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Muacevic A, Adler JR, Agboola AA, Mohamed KH, Mohamed AS, Zahid N, Haseeb M, Nasir H. Immune Thrombocytopenia and Cerebral Venous Sinus Thrombosis Following COVID-19 Vaccination: A Case Report. Cureus 2023; 15:e34272. [PMID: 36855477 PMCID: PMC9968471 DOI: 10.7759/cureus.34272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2023] [Indexed: 01/28/2023] Open
Abstract
Mass vaccination against coronavirus disease 2019 (COVID-19) has been safe and effective. The ongoing emergence of vaccine-induced complications has challenged the public trust in vaccination programs and, though uncommon, can lead to significant morbidity and mortality. Vaccine-induced immune thrombocytopenia and thrombosis (VITT) is a rare and fatal complication of the COVID-19 vaccine. We present a rare case of VITT in a young female who presented with worsening headache, body rash with deteriorating neurological deficit after 12 days of the second dose of the ChAdOx1 COVID-19 vaccine. Initial blood tests showed thrombocytopenia with deranged clotting time and D-dimer levels. Her computed tomography venogram showed thrombosis in the left transverse sinus, and she was diagnosed with a provisional diagnosis of VITT. She initially managed with dexamethasone, intravenous immunoglobulins, and apixaban to reverse the autoimmune process. Our case highlights the clinical course, diagnosis, and management of VITT, which will assist physicians in the timely recognition and adequate management of VITT.
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8
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Ruzicka M, Wurm S, Lindner L, Dreyling M, von Bergwelt-Baildon M, Boeck S, Giessen-Jung C, Milani V, Stemmler JH, Subklewe M, Weigert O, Spiekermann K. Treatment, outcome and re-vaccination of patients with SARS-CoV-2 vaccine-associated immune thrombocytopenia. Infection 2023; 51:231-238. [PMID: 36195695 PMCID: PMC9531644 DOI: 10.1007/s15010-022-01909-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/15/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE Following the emergency use authorization of BNT162b2 by the Food and Drug administration (FDA) in early December 2020, mRNA- and vector-based vaccines became an important means of reducing the spread and mortality of the COVID-19 pandemic. The European Medicines Agency labelled immune thrombocytopenia (ITP) as a rare adverse reaction of unknown frequency after vector-, but not mRNA-vaccination. Here, we report on the long-term outcome of 6 patients who were diagnosed with de-novo, vaccine-associated ITP (VA-ITP), and on the outcome of subsequent SARS-CoV-2 re-vaccinations. METHODS Patients were included after presenting to our emergency department. Therapy was applied according to ITP guidelines. Follow-up data were obtained from outpatient departments. Both mRNA- or vector-based vaccines were each used in 3 cases, respectively. RESULTS In all patients, the onset of symptoms occurred after the 1st dose of vaccine was applied. 5 patients required treatment, 3 of them 2nd line therapy. All patients showed a complete response eventually. After up to 359 days of follow-up, 2 patients were still under 2nd line therapy with thrombopoietin receptor agonists. 5 patients have been re-vaccinated with up to 3 consecutive doses of SARS-CoV-2 vaccines, 4 of them showing stable platelet counts hereafter. CONCLUSION Thrombocytopenia after COVID-19 vaccination should trigger a diagnostic workup to exclude vaccine-induced immune thrombotic thrombocytopenia (VITT) and, if confirmed, VA-ITP should be treated according to current ITP guidelines. Re-vaccination of patients seems feasible under close monitoring of blood counts and using a vaccine that differs from the one triggering the initial episode of VA-ITP.
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Affiliation(s)
- Michael Ruzicka
- Department of Medicine III, LMU Klinikum, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Sonja Wurm
- Department of Medicine III, LMU Klinikum, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany ,Division of Hematology, Medical University of Graz, Graz, Austria
| | - Lars Lindner
- Department of Medicine III, LMU Klinikum, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Martin Dreyling
- Department of Medicine III, LMU Klinikum, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | | | - Stefan Boeck
- Department of Medicine III, LMU Klinikum, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Clemens Giessen-Jung
- Department of Medicine III, LMU Klinikum, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Valeria Milani
- Facharztzentrum Fürstenfeldbruck, Fürstenfeldbruck, Germany
| | - Joachim H. Stemmler
- Department of Medicine III, LMU Klinikum, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Marion Subklewe
- Department of Medicine III, LMU Klinikum, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Oliver Weigert
- Department of Medicine III, LMU Klinikum, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Karsten Spiekermann
- Department of Medicine III, LMU Klinikum, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
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Dainese C, Valeri F, Bardetta M, Sella C, Porreca A, Valpreda A, Pittaluga F, Mengozzi G, Bruno B, Borchiellini A. Impact of COVID-19 Infection, Vaccination, and Serological Response in Immune Thrombocytopenic Purpura Patients: A Single-Center Global Analysis. Biomedicines 2022; 10:2674. [PMID: 36359194 PMCID: PMC9687178 DOI: 10.3390/biomedicines10112674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/17/2022] [Accepted: 10/20/2022] [Indexed: 11/17/2023] Open
Abstract
Both SARS-CoV-2 infection and vaccination have raised concern in immune-mediated diseases, including immune thrombocytopenic purpura (ITP) considering risk of de novo ITP development and ITP recurrence. Here, we report on data from a single-center retrospective-prospective collection aiming to evaluate platelet (plt) dynamics in patients (pts) with chronic ITP after COVID-19 infection (before and after vaccination) and after the first, second and third vaccine doses. Furthermore, we analyzed the serological response after the first two doses of COVID-19 vaccination. A total of 64 pts currently followed for chronic ITP who experienced COVD-19 infection and/or vaccination with an available plt count before and after such events were included in the analysis. A low incidence of ITP exacerbation following vaccine sessions (6-16%) was observed in comparison with a high frequency of exacerbation and rescue treatment necessity after COVID-19 infection in unvaccinated pts (83%). Moreover, the lower ITP exacerbation rate observed in infected pts previously vaccinated (18%) suggests further protective effects in this population. Finally, a high seroconversion rate was observed, confirming data reported in previously published studies on immune cytopenia and rheumatological diseases, but more evidence is awaited to establish the clinical impact of serological response.
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Affiliation(s)
- Cristina Dainese
- Regional Reference Center for Thrombotic and Haemorrhagic Disorders of the Adult, Department of Hematology and Oncology, Hematology Divison, University Hospital City of Science and Health Molinette, 10126 Turin, Italy
| | - Federica Valeri
- Regional Reference Center for Thrombotic and Haemorrhagic Disorders of the Adult, Department of Hematology and Oncology, Hematology Divison, University Hospital City of Science and Health Molinette, 10126 Turin, Italy
| | - Marco Bardetta
- Regional Reference Center for Thrombotic and Haemorrhagic Disorders of the Adult, Department of Hematology and Oncology, Hematology Divison, University Hospital City of Science and Health Molinette, 10126 Turin, Italy
| | - Carola Sella
- Regional Reference Center for Thrombotic and Haemorrhagic Disorders of the Adult, Department of Hematology and Oncology, Hematology Divison, University Hospital City of Science and Health Molinette, 10126 Turin, Italy
| | - Annamaria Porreca
- Department of Medical, Oral and Biotechnologies Sciences, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Alessandra Valpreda
- Clinical Biochemistry Laboratory, University Hospital City of Science and Health Molinette, 10126 Turin, Italy
| | - Fabrizia Pittaluga
- Laboratory of Microbiology and Virology, University Hospital City of Science and Health Molinette, 10126 Turin, Italy
| | - Giulio Mengozzi
- Clinical Biochemistry Laboratory, University Hospital City of Science and Health Molinette, 10126 Turin, Italy
| | - Benedetto Bruno
- Hematology Division, Department of Hematology and Oncology, Azienda Ospedaliera Città della Salute e della Scienza di Torino-Molinette, 10126 Turin, Italy
| | - Alessandra Borchiellini
- Regional Reference Center for Thrombotic and Haemorrhagic Disorders of the Adult, Department of Hematology and Oncology, Hematology Divison, University Hospital City of Science and Health Molinette, 10126 Turin, Italy
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10
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Liu W, Wu T, Xue F, Tian H, Song R, Bai H. Immune thrombocytopenic purpura induced by the COVID‑19 vaccine after the second dose in a 78‑year‑old patient: A case report. Exp Ther Med 2022; 24:580. [PMID: 35949340 PMCID: PMC9353547 DOI: 10.3892/etm.2022.11517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/27/2022] [Indexed: 01/08/2023] Open
Affiliation(s)
- Wenhui Liu
- Department of Hematology, The 940th Hospital of Joint Logistics Support Force of The Chinese People's Liberation Army, Lanzhou, Gansu 730050, P.R. China
| | - Tao Wu
- Department of Hematology, The 940th Hospital of Joint Logistics Support Force of The Chinese People's Liberation Army, Lanzhou, Gansu 730050, P.R. China
| | - Feng Xue
- Department of Hematology, The 940th Hospital of Joint Logistics Support Force of The Chinese People's Liberation Army, Lanzhou, Gansu 730050, P.R. China
| | - Hongjuan Tian
- Department of Hematology, The 940th Hospital of Joint Logistics Support Force of The Chinese People's Liberation Army, Lanzhou, Gansu 730050, P.R. China
| | - Rui Song
- Department of Hematology, The 940th Hospital of Joint Logistics Support Force of The Chinese People's Liberation Army, Lanzhou, Gansu 730050, P.R. China
| | - Hai Bai
- Department of Hematology, The 940th Hospital of Joint Logistics Support Force of The Chinese People's Liberation Army, Lanzhou, Gansu 730050, P.R. China
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Hillier K, Rothman JA, Klaassen RJ, Neunert C, Rose MJ, Grace RF, Lambert MP. SARS-CoV-2 vaccination in pediatric patients with immune thrombocytopenia. Pediatr Blood Cancer 2022; 69:e29760. [PMID: 35561101 PMCID: PMC9347939 DOI: 10.1002/pbc.29760] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/12/2022] [Accepted: 04/18/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Kirsty Hillier
- Department of PediatricsDivision of Pediatric Hematology‐OncologyHassenfeld Children's Hospital at NYU Langone HealthNYU Grossman School of MedicineNew YorkNew YorkUSA
| | - Jennifer A. Rothman
- Department of PediatricsDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Robert J. Klaassen
- Division of Hematology/Oncology, Department of PediatricsChildren's Hospital of Eastern Ontario Research InstituteOttawaOntarioCanada
| | - Cindy Neunert
- Division of Hematology/Oncology/Stem Cell Transplant, Department of PediatricsColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Melissa J. Rose
- Nationwide Children's and The Ohio State University Wexner Medical CenterColumbusOhioUSA
| | - Rachael F. Grace
- Pediatric Hematology/OncologyDana‐Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical SchoolBostonMassachusettsUSA
| | - Michele P. Lambert
- Division of HematologyThe Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of PediatricsPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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12
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Küster O, Schmohl J, Greiner J, Storz MA. Severe immune thrombocytopenia following diphtheria, tetanus, pertussis and polio vaccination in a 36-year-old Caucasian woman: a case report. Eur J Med Res 2022; 27:63. [PMID: 35505368 PMCID: PMC9062629 DOI: 10.1186/s40001-022-00686-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 04/11/2022] [Indexed: 12/29/2022] Open
Abstract
Background Immune thrombocytopenia (ITP) is a rare autoimmune disorder characterized by low platelet counts and increased bleeding risk. The disease may be induced by other disorders, including malignancies, autoimmune diseases, infectious agents or drugs. However, ITP has also been described following vaccinations, such as the measles–mumps–rubella vaccination. In rare cases, ITP may occur in children who received a DTaP-IP (diphtheria, tetanus, acellular pertussis vaccine and inactivated poliovirus) vaccine. Hereinafter, we report the first well-documented cases of ITP in an adult patient in the temporal context of a DTaP-IP vaccination. Case presentation This case report attempts to capture the life-threatening picture of a 36-year-old otherwise healthy Caucasian woman with newly diagnosed severe immune thrombocytopenia in the temporal context of a DTaP-IP vaccination. Four days after receiving the vaccine, the women presented to her primary care physician with malaise, fever and recurrent epistaxis. Clinical examination revealed oral petechiae, ecchymoses, and non-palpable petechiae on both legs. The patient was immediately referred to a local hematology unit where she developed hematuria and an intestinal bleeding (WHO Bleeding Grade III) requiring multiple transfusions. After receiving oral corticosteroids and intravenous immunoglobulins, her platelets gradually recovered. Common causes of secondary ITP were ruled out by laboratory investigations, bone marrow and peripheral blood examinations. This raises the possibility of a (secondary) vaccination-associated thrombocytopenia. To the best of our knowledge, this is the first well-documented case of a DTaP-IP vaccination-related ITP in an adult patient in the English literature. Conclusion Although a causal connection between both entities may not be established, we would like to raise awareness in clinicians that ITP following DTaP-IP vaccinations is potentially not limited to children, but may also occur in adults. Users of DTaP-IP booster vaccines should be alert of the possibility of such adverse reactions. Supplementary Information The online version contains supplementary material available at 10.1186/s40001-022-00686-z.
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Affiliation(s)
- Onno Küster
- MVZ Dillmannstraße, Dillmannstraße 19, 70193, Stuttgart, Baden-Württemberg, Germany
| | - Jörg Schmohl
- Department of Internal Medicine, Diakonie Hospital Stuttgart, 70176, Stuttgart, Germany
| | - Jochen Greiner
- Department of Internal Medicine, Diakonie Hospital Stuttgart, 70176, Stuttgart, Germany
| | - Maximilian Andreas Storz
- Department of Internal Medicine II, Center for Complementary Medicine, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany.
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13
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Sivaramakrishnan P, Mishra M. Vaccination-associated immune thrombocytopenia possibly due to ChAdOx1 nCoV-19 (Covishield) coronavirus vaccine. BMJ Case Rep 2022; 15:15/3/e249237. [PMID: 35354570 PMCID: PMC8969046 DOI: 10.1136/bcr-2022-249237] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Immune thrombocytopenia (ITP) is an acquired haemorrhagic diathesis of immune-mediated destruction, impaired production or increased splenic sequestration of platelets. It can be idiopathic (primary) or secondary (infections, medications, HIV infection, malignancies, connective tissue diseases or rarely secondary to vaccination). ITP postvaccination is termed vaccine-associated ITP (VITP) and is known to be caused by vaccines against various infectious agents such as measles-mumps-rubella, Haemophilus influenzae, pneumococcus, hepatitis B virus and human papilloma virus. Cases of VITP post SARS-CoV-2 vaccination have also been reported in the literature. Various hypotheses on the occurrence of the same are theorised, but no single theory has been proven to cause VITP conclusively. Management includes routine treatment of ITP with use of agents such as steroids, intravenous immunoglobulins, or on rare occasions a thrombopoietic agent or vinca alkaloids. We present a case of VITP possibly due to ChAdOx1 nCoV-19 (Covishield) vaccination in a middle-aged woman who responded to steroid therapy.
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Affiliation(s)
- Prakash Sivaramakrishnan
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Mayank Mishra
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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14
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De Stefano V, Candelli M, Rossi E, Franceschi F. Response to correspondence in reference to the previously published Epub manuscript: immune thrombocytopenic purpura after SARS-CoV-2 vaccine. Br J Haematol 2021; 194:e95-e96. [PMID: 34170008 PMCID: PMC8444647 DOI: 10.1111/bjh.17631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Valerio De Stefano
- Diagnostic ImagingOncological Radiotherapy, and Hematology departmentFondazione Universitaria Policlinico A. Gemelli‐IRCCS–Catholic University of Sacred Heart of RomeRomaItaly
| | - Marcello Candelli
- Emergency Medicine DepartmentFondazione Universitaria Policlinico A. Gemelli‐IRCCS–Catholic University of Sacred Heart of RomeRomaItaly
| | - Elena Rossi
- Diagnostic ImagingOncological Radiotherapy, and Hematology departmentFondazione Universitaria Policlinico A. Gemelli‐IRCCS–Catholic University of Sacred Heart of RomeRomaItaly
| | - Francesco Franceschi
- Emergency Medicine DepartmentFondazione Universitaria Policlinico A. Gemelli‐IRCCS–Catholic University of Sacred Heart of RomeRomaItaly
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15
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Koch M, Fuld S, Middeke JM, Fantana J, von Bonin S, Beyer-Westendorf J. Secondary Immune Thrombocytopenia (ITP) Associated with ChAdOx1 Covid-19 Vaccination - A Case Report. TH OPEN 2021; 5:e315-e318. [PMID: 34377889 PMCID: PMC8324423 DOI: 10.1055/s-0041-1731774] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/08/2021] [Indexed: 11/06/2022] Open
Abstract
Novel mRNA and vector-based covid-19 vaccinations have shown high efficacy in preventing symptomatic COVID-19 infections. Compared with the number of performed vaccinations, rates of severe side effects seem low. Rare prothrombotic coagulation disorders with suspected association to ChAdOx1 nCoV-19 (AstraZeneca) have been reported. These cases have gathered considerable media attention and caused a temporary pause of usage of the AstraZeneca vaccine in Europe and several other countries and are currently discussed as vaccine-induced immune thrombotic thrombocytopenia (VITT). However, hemorrhagic complications from ChAdOx1 nCoV-19 vaccination have also been reported but, so far, received less public attention despite considerable potential for life-threatening complications. Here we present a case of severe immune thrombocytopenia after ChAdOx1 covid-19 vaccination and its successful primary management.
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Affiliation(s)
- Martin Koch
- Department of Medicine, Hematology Division, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Sybille Fuld
- Department of Medicine, Nephrology Division, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Jan M Middeke
- Department of Medicine, Hematology Division, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Julia Fantana
- Department of Medicine, Emergency and Intensive Medicine Division, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Simone von Bonin
- Department of Medicine, Emergency and Intensive Medicine Division, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Jan Beyer-Westendorf
- Department of Medicine, Hematology Division, University Hospital Carl Gustav Carus, Dresden, Germany
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16
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Autoimmune Hematologic Disorders in Two Patients After mRNA COVID-19 Vaccine. Hemasphere 2021; 5:e618. [PMID: 34263143 PMCID: PMC8274740 DOI: 10.1097/hs9.0000000000000618] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/12/2021] [Accepted: 06/16/2021] [Indexed: 12/18/2022] Open
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Shah SRA, Dolkar S, Mathew J, Vishnu P. COVID-19 vaccination associated severe immune thrombocytopenia. Exp Hematol Oncol 2021; 10:42. [PMID: 34266487 PMCID: PMC8280588 DOI: 10.1186/s40164-021-00235-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/07/2021] [Indexed: 12/18/2022] Open
Abstract
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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Affiliation(s)
- Syed Raza Ali Shah
- Departments of Hospital Medicine, St. Michael Medical Center, Virginia Mason Franciscan Health, Silverdale, WA, USA. .,, 4655 Olivine Dr SW, Port Orchard, WA, 98367, USA.
| | - Sherpa Dolkar
- Departments of Hospital Medicine, St. Michael Medical Center, Virginia Mason Franciscan Health, Silverdale, WA, USA
| | - Jacob Mathew
- Departments of Hematology, St. Michael Medical Center, Virginia Mason Franciscan Health, Silverdale, WA, USA
| | - Prakash Vishnu
- Departments of Hematology, St. Michael Medical Center, Virginia Mason Franciscan Health, Silverdale, WA, USA
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Kuter DJ. Exacerbation of immune thrombocytopenia following COVID-19 vaccination. Br J Haematol 2021; 195:365-370. [PMID: 34075578 PMCID: PMC8239625 DOI: 10.1111/bjh.17645] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 05/26/2021] [Indexed: 02/06/2023]
Abstract
There is concern that COVID‐19 vaccination may adversely affect immune thrombocytopenia (ITP) patients. Fifty‐two consecutive chronic ITP patients were prospectively followed after COVID‐19 vaccination. Fifteen percent had no worsening of clinical symptoms but no post‐vaccination platelet count; 73% had no new symptoms and no significant platelet count decline. However, 12% had a median platelet count drop of 96% within 2–5 days post vaccination with new bleeding symptoms; after rescue therapy with corticosteroids +/− intravenous immunoglobulin (IVIG), platelets recovered to >30 × 109/l a median three days later. ITP exacerbation occurred independently of remission status, concurrent ITP treatment, or vaccine type. Safety of a second vaccine dose needs careful assessment.
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Affiliation(s)
- David J Kuter
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Fueyo-Rodriguez O, Valente-Acosta B, Jimenez-Soto R, Neme-Yunes Y, Inclán-Alarcón SI, Trejo-Gonzalez R, García-Salcido MÁ. Secondary immune thrombocytopenia supposedly attributable to COVID-19 vaccination. BMJ Case Rep 2021; 14:14/5/e242220. [PMID: 34059544 PMCID: PMC8169472 DOI: 10.1136/bcr-2021-242220] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Immune thrombocytopenia (ITP) has been widely reported as a complication of SARS-CoV-2 infection, but to our knowledge, there have been no reports on the association of the COVID-19 vaccine with thrombocytopenia. Here, we report a case of secondary ITP in a patient who was recently immunised with the messenger RNA COVID-19 vaccine BNT162b2 (Pfizer–BioNTech).
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20
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Julian JA, Mathern DR, Fernando D. Idiopathic Thrombocytopenic Purpura and the Moderna Covid-19 Vaccine. Ann Emerg Med 2021; 77:654-656. [PMID: 34030782 PMCID: PMC7879100 DOI: 10.1016/j.annemergmed.2021.02.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Indexed: 10/27/2022]
Affiliation(s)
| | | | - Dinali Fernando
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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