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COVID-19 vaccination associated severe immune thrombocytopenia.
Exp Hematol Oncol. 2021 Jul 15; 10(1):42.EH

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.

Authors+Show Affiliations

Departments of Hospital Medicine, St. Michael Medical Center, Virginia Mason Franciscan Health, Silverdale, WA, USA. syedrashah@gmail.com. , 4655 Olivine Dr SW, Port Orchard, WA, 98367, USA. syedrashah@gmail.com.Departments of Hospital Medicine, St. Michael Medical Center, Virginia Mason Franciscan Health, Silverdale, WA, USA.Departments of Hematology, St. Michael Medical Center, Virginia Mason Franciscan Health, Silverdale, WA, USA.Departments of Hematology, St. Michael Medical Center, Virginia Mason Franciscan Health, Silverdale, WA, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

34266487

Citation

Shah, Syed Raza Ali, et al. "COVID-19 Vaccination Associated Severe Immune Thrombocytopenia." Experimental Hematology & Oncology, vol. 10, no. 1, 2021, p. 42.
Shah SRA, Dolkar S, Mathew J, et al. COVID-19 vaccination associated severe immune thrombocytopenia. Exp Hematol Oncol. 2021;10(1):42.
Shah, S. R. A., Dolkar, S., Mathew, J., & Vishnu, P. (2021). COVID-19 vaccination associated severe immune thrombocytopenia. Experimental Hematology & Oncology, 10(1), 42. https://doi.org/10.1186/s40164-021-00235-0
Shah SRA, et al. COVID-19 Vaccination Associated Severe Immune Thrombocytopenia. Exp Hematol Oncol. 2021 Jul 15;10(1):42. PubMed PMID: 34266487.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - COVID-19 vaccination associated severe immune thrombocytopenia. AU - Shah,Syed Raza Ali, AU - Dolkar,Sherpa, AU - Mathew,Jacob, AU - Vishnu,Prakash, Y1 - 2021/07/15/ PY - 2021/06/01/received PY - 2021/07/07/accepted PY - 2021/7/16/entrez PY - 2021/7/17/pubmed PY - 2021/7/17/medline KW - Coronavirus disease 2019 KW - Immune thrombocytopenia KW - Johnson and Johnson COVID-19 vaccine KW - Pfizer-BioNTech COVID-19 vaccine SP - 42 EP - 42 JF - Experimental hematology & oncology JO - Exp Hematol Oncol VL - 10 IS - 1 N2 - 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. SN - 2162-3619 UR - https://www.unboundmedicine.com/medline/citation/34266487/COVID-19_vaccination_associated_severe_immune_thrombocytopenia. L2 - https://ehoonline.biomedcentral.com/articles/10.1186/s40164-021-00235-0 DB - PRIME DP - Unbound Medicine ER -
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