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SARS-CoV-2 Vaccination and Immune Thrombocytopenia in de novo and pre-existing ITP patients.
Blood. 2021 Sep 29 [Online ahead of print]Blood

Abstract

Cases of de novo immune thrombocytopenia (ITP) - including a fatality - following SARS-CoV-2 vaccination in previously healthy recipients led to studying its impact in pre-existing ITP. In this study, four data sources were analyzed: the Vaccine Adverse Events Reporting System (VAERS) for cases of de novo ITP; a ten-center retrospective study of adults with pre-existing ITP receiving SARS-CoV-2 vaccination; and surveys distributed by the Platelet Disorder Support Association (PDSA, United States) and the United Kingdom (UK) ITP Support Association. Seventy-seven de novo ITP cases were identified in VAERS, presenting with median platelet count of 3 [1-9] x109/L approximately 1-week post-vaccination. Of 28 patients with available data, 26 responded to treatment with corticosteroids and/or intravenous immunoglobulin (IVIG), and/or platelet transfusions. Among 109 patients with pre-existing ITP who received a SARS-CoV-2 vaccine, 19 experienced an ITP exacerbation (any of: ≥50% decline in platelet count, nadir platelet count <30x109/L with >20% decrease from baseline, and/or use of rescue therapy) following the first dose and 14 of 70 after a second dose. Splenectomized persons and those who received 5 or more prior lines of therapy were at highest risk of ITP exacerbation. Fifteen patients received and responded to rescue treatment. In surveys of both 57 PDSA and 43 UK ITP patients, prior splenectomy was associated with worsened thrombocytopenia. ITP may worsen in pre-existing ITP or be identified de novo post-SARS-CoV2-vaccination; both situations responded well to treatment. Proactive monitoring of patients with known ITP, especially those post-splenectomy and with more refractory disease, is indicated.

Authors+Show Affiliations

Weill Cornell Medical Center, New York, New York, United States.NewYork-Presbyterian Hospital, New York, New York, United States.Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States.University of Pennsylvania, Philadelphia, Pennsylvania, United States.Platelet Disorder Support Assotiation, Clevelend, Ohio, United States.University of Washington, Seattle, Washington, United States.Platelet Disorder Support Association, Cleveland, Ohio, United States.Georgetown University Medical Center, Washington, District of Columbia, United States.Platelet Disorder Support Association (PDSA), Cleveland, Ohio, United States.University of California San Francisco, San Francisco, California, United States.Yale University School of Medicine, New Haven, Connecticut, United States.University of Southern California, Los Angeles, California, United States.The Royal London Hospital, United Kingdom.Weill Cornell Medical Center, New York, New York, United States.University of Illinois College of Medicine-Peoria, United States.Manchester University Hospitals, Manchester, United Kingdom.Massachusetts General Hospital, Boston, Mississippi, United States.Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, Philadelphia, Pennsylvania, United States.Department of Pediatrics, Division of Hematology/Oncology, Weill Cornell Medicine, New York, New York, United States.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

34587251

Citation

Lee, Eun-Ju, et al. "SARS-CoV-2 Vaccination and Immune Thrombocytopenia in De Novo and Pre-existing ITP Patients." Blood, 2021.
Lee EJ, Beltrami Moreira M, Al-Samkari H, et al. SARS-CoV-2 Vaccination and Immune Thrombocytopenia in de novo and pre-existing ITP patients. Blood. 2021.
Lee, E. J., Beltrami Moreira, M., Al-Samkari, H., Cuker, A., DiRaimo, J., Gernsheimer, T., Kruse, A., Kessler, C. M., Kruse, C., Leavitt, A. D., Lee, A. I., Liebman, H. A., Newland, A. C., Ray, A. E., Tarantino, M. D., Thachil, J., Kuter, D. J., Cines, D. B., & Bussel, J. B. (2021). SARS-CoV-2 Vaccination and Immune Thrombocytopenia in de novo and pre-existing ITP patients. Blood. https://doi.org/10.1182/blood.2021013411
Lee EJ, et al. SARS-CoV-2 Vaccination and Immune Thrombocytopenia in De Novo and Pre-existing ITP Patients. Blood. 2021 Sep 29; PubMed PMID: 34587251.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - SARS-CoV-2 Vaccination and Immune Thrombocytopenia in de novo and pre-existing ITP patients. AU - Lee,Eun-Ju, AU - Beltrami Moreira,Marina, AU - Al-Samkari,Hanny, AU - Cuker,Adam, AU - DiRaimo,Jennifer, AU - Gernsheimer,Terry, AU - Kruse,Alexandra, AU - Kessler,Craig M, AU - Kruse,Caroline, AU - Leavitt,Andrew D, AU - Lee,Alfred I, AU - Liebman,Howard Allen, AU - Newland,Adrian C, AU - Ray,Ashley E, AU - Tarantino,Michael D, AU - Thachil,Jecko, AU - Kuter,David J, AU - Cines,Douglas B, AU - Bussel,James B, Y1 - 2021/09/29/ PY - 2021/09/13/accepted PY - 2021/07/23/received PY - 2021/09/01/revised PY - 2021/9/29/entrez PY - 2021/9/30/pubmed PY - 2021/9/30/medline JF - Blood JO - Blood N2 - Cases of de novo immune thrombocytopenia (ITP) - including a fatality - following SARS-CoV-2 vaccination in previously healthy recipients led to studying its impact in pre-existing ITP. In this study, four data sources were analyzed: the Vaccine Adverse Events Reporting System (VAERS) for cases of de novo ITP; a ten-center retrospective study of adults with pre-existing ITP receiving SARS-CoV-2 vaccination; and surveys distributed by the Platelet Disorder Support Association (PDSA, United States) and the United Kingdom (UK) ITP Support Association. Seventy-seven de novo ITP cases were identified in VAERS, presenting with median platelet count of 3 [1-9] x109/L approximately 1-week post-vaccination. Of 28 patients with available data, 26 responded to treatment with corticosteroids and/or intravenous immunoglobulin (IVIG), and/or platelet transfusions. Among 109 patients with pre-existing ITP who received a SARS-CoV-2 vaccine, 19 experienced an ITP exacerbation (any of: ≥50% decline in platelet count, nadir platelet count <30x109/L with >20% decrease from baseline, and/or use of rescue therapy) following the first dose and 14 of 70 after a second dose. Splenectomized persons and those who received 5 or more prior lines of therapy were at highest risk of ITP exacerbation. Fifteen patients received and responded to rescue treatment. In surveys of both 57 PDSA and 43 UK ITP patients, prior splenectomy was associated with worsened thrombocytopenia. ITP may worsen in pre-existing ITP or be identified de novo post-SARS-CoV2-vaccination; both situations responded well to treatment. Proactive monitoring of patients with known ITP, especially those post-splenectomy and with more refractory disease, is indicated. SN - 1528-0020 UR - https://www.unboundmedicine.com/medline/citation/34587251/SARS_CoV_2_Vaccination_and_Immune_Thrombocytopenia_in_de_novo_and_pre_existing_ITP_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0006-4971(21)01672-4 DB - PRIME DP - Unbound Medicine ER -