Exacerbation of immune thrombocytopenia following COVID-19 vaccination

Br J Haematol. 2021 Nov;195(3):365-370. doi: 10.1111/bjh.17645. Epub 2021 Jun 24.

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.

Keywords: COVID-19; bleeding; immune thrombocytopenia; rescue; vaccination.

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Adult
  • Aged
  • COVID-19 / complications
  • COVID-19 / pathology
  • COVID-19 / prevention & control*
  • COVID-19 Vaccines / adverse effects*
  • Female
  • Follow-Up Studies
  • Hemorrhage / etiology*
  • Hemorrhage / pathology
  • Hemorrhage / therapy
  • Humans
  • Immunoglobulins, Intravenous / therapeutic use
  • Male
  • Middle Aged
  • Platelet Count
  • Prospective Studies
  • Purpura, Thrombocytopenic, Idiopathic / complications*
  • Purpura, Thrombocytopenic, Idiopathic / pathology
  • Purpura, Thrombocytopenic, Idiopathic / therapy
  • Severity of Illness Index
  • Young Adult

Substances

  • Adrenal Cortex Hormones
  • COVID-19 Vaccines
  • Immunoglobulins, Intravenous