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Severe, Refractory Immune Thrombocytopenia Occurring After SARS-CoV-2 Vaccine.
J Blood Med. 2021; 12:221-224.JB

Abstract

The rollout of the SARS-CoV-2 vaccine is underway, and millions have already been vaccinated. At least 25 reports of "immune thrombocytopenia" (ITP) or "thrombocytopenia" following the Moderna or Pfizer vaccine have been added to the Vaccine Adverse Event Reporting System (VAERS) in the US. ITP is a rare but known complication of several vaccinations. SARS-CoV-2 vaccine is new, with a novel mechanism of action, and understanding the epidemiology, clinical manifestations, treatment success and natural history of post-vaccination thrombocytopenia is evolving. We report a 74-year-old man who developed refractory thrombocytopenia within one day of receiving the Moderna SARS-CoV-2 vaccine. Several hours after vaccination, he developed significant epistaxis and cutaneous purpura. Severe thrombocytopenia was documented the following day, and he developed extremity weakness and encephalopathy with facial muscle weakness. Over a 14-day period, thrombocytopenia was treated first with high dose dexamethasone, intravenous immunoglobulin, platelet transfusions, rituximab, plasma exchange (for presumed acute inflammatory demyelinating polyneuropathy (AIDP)), and four daily doses of the thrombopoietin receptor agonist (TPO-RA) eltrombopag (Promacta™), without a platelet response. Three days later, he received the TPO-RA romiplostim (Nplate™). Five days later, his platelet count began to rise and by post-vaccination day 25, his platelet count was in the normal range. Thrombocytopenia was refractory to frontline and second-line treatment. The eventual rise in his platelet count suggests that one or both TPO-RAs may have impacted platelet recovery. Possibly, but less likely given the temporality, the drug-induced thrombocytopenia was subsiding. The aggressive use of immunosuppressive treatment may jeopardize the intended purpose of the SARS-CoV-2 vaccine, and earlier use of non-immunosuppressive second-line treatment for vaccine-related severe thrombocytopenia, such as with TPO-RAs, should be considered. While it is imperative to continue the global vaccination program, vigilance to the occurrence of post-vaccination severe thrombocytopenia is warranted.

Authors+Show Affiliations

The Bleeding and Clotting Disorders Institute, Peoria, IL, USA.The Bleeding and Clotting Disorders Institute, Peoria, IL, USA.The Bleeding and Clotting Disorders Institute, Peoria, IL, USA. Department of Medicine, University of Illinois College of Medicine-Peoria, Peoria, IL, USA.Department of Medicine, Saint Francis Medical Center, Peoria, IL, USA.Department of Medicine, University of Illinois College of Medicine-Peoria, Peoria, IL, USA. Department of Medicine, Saint Francis Medical Center, Peoria, IL, USA.Department of Medicine, OSF Sacred Heart Medical Center, Danville, IL, USA.The Bleeding and Clotting Disorders Institute, Peoria, IL, USA. Department of Medicine, University of Illinois College of Medicine-Peoria, Peoria, IL, USA.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

33854395

Citation

Helms, Jackie M., et al. "Severe, Refractory Immune Thrombocytopenia Occurring After SARS-CoV-2 Vaccine." Journal of Blood Medicine, vol. 12, 2021, pp. 221-224.
Helms JM, Ansteatt KT, Roberts JC, et al. Severe, Refractory Immune Thrombocytopenia Occurring After SARS-CoV-2 Vaccine. J Blood Med. 2021;12:221-224.
Helms, J. M., Ansteatt, K. T., Roberts, J. C., Kamatam, S., Foong, K. S., Labayog, J. S., & Tarantino, M. D. (2021). Severe, Refractory Immune Thrombocytopenia Occurring After SARS-CoV-2 Vaccine. Journal of Blood Medicine, 12, 221-224. https://doi.org/10.2147/JBM.S307047
Helms JM, et al. Severe, Refractory Immune Thrombocytopenia Occurring After SARS-CoV-2 Vaccine. J Blood Med. 2021;12:221-224. PubMed PMID: 33854395.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Severe, Refractory Immune Thrombocytopenia Occurring After SARS-CoV-2 Vaccine. AU - Helms,Jackie M, AU - Ansteatt,Kristin T, AU - Roberts,Jonathan C, AU - Kamatam,Sravani, AU - Foong,Kap Sum, AU - Labayog,Jo-Mel S, AU - Tarantino,Michael D, Y1 - 2021/04/06/ PY - 2021/02/18/received PY - 2021/03/15/accepted PY - 2021/4/15/entrez PY - 2021/4/16/pubmed PY - 2021/4/16/medline KW - SARS-CoV-2 KW - immune thrombocytopenic purpura KW - platelet KW - thrombocytopenia KW - thrombopoietin receptor agonist KW - vaccine SP - 221 EP - 224 JF - Journal of blood medicine JO - J Blood Med VL - 12 N2 - The rollout of the SARS-CoV-2 vaccine is underway, and millions have already been vaccinated. At least 25 reports of "immune thrombocytopenia" (ITP) or "thrombocytopenia" following the Moderna or Pfizer vaccine have been added to the Vaccine Adverse Event Reporting System (VAERS) in the US. ITP is a rare but known complication of several vaccinations. SARS-CoV-2 vaccine is new, with a novel mechanism of action, and understanding the epidemiology, clinical manifestations, treatment success and natural history of post-vaccination thrombocytopenia is evolving. We report a 74-year-old man who developed refractory thrombocytopenia within one day of receiving the Moderna SARS-CoV-2 vaccine. Several hours after vaccination, he developed significant epistaxis and cutaneous purpura. Severe thrombocytopenia was documented the following day, and he developed extremity weakness and encephalopathy with facial muscle weakness. Over a 14-day period, thrombocytopenia was treated first with high dose dexamethasone, intravenous immunoglobulin, platelet transfusions, rituximab, plasma exchange (for presumed acute inflammatory demyelinating polyneuropathy (AIDP)), and four daily doses of the thrombopoietin receptor agonist (TPO-RA) eltrombopag (Promacta™), without a platelet response. Three days later, he received the TPO-RA romiplostim (Nplate™). Five days later, his platelet count began to rise and by post-vaccination day 25, his platelet count was in the normal range. Thrombocytopenia was refractory to frontline and second-line treatment. The eventual rise in his platelet count suggests that one or both TPO-RAs may have impacted platelet recovery. Possibly, but less likely given the temporality, the drug-induced thrombocytopenia was subsiding. The aggressive use of immunosuppressive treatment may jeopardize the intended purpose of the SARS-CoV-2 vaccine, and earlier use of non-immunosuppressive second-line treatment for vaccine-related severe thrombocytopenia, such as with TPO-RAs, should be considered. While it is imperative to continue the global vaccination program, vigilance to the occurrence of post-vaccination severe thrombocytopenia is warranted. SN - 1179-2736 UR - https://www.unboundmedicine.com/medline/citation/33854395/Severe,_Refractory_Immune_Thrombocytopenia_Occurring_After_SARS-CoV-2_Vaccine. DB - PRIME DP - Unbound Medicine ER -
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