Case Report

Re-Visiting Immune Thrombocytopenia with Covid-19 Vaccination: A Case Report

Abstract

The Covid-19 pandemic has seen the emergence of various vaccines being produced at an unprecedented speed. It is not surprising that new adverse events to these vaccines are still being reported and Immune thrombocytopenic Purpura [ITP] happens to be one among them. Moderna and Pfizer vaccine have been linked to it. Association of ITP with SARS-CoV-2 vaccine is poorly understood. We present to you a case of severe symptomatic thrombocytopenia post ChAdOx1 nCoV-19 vaccination which responded to conventional therapies. Aggressive use of immunosuppressive treatment may jeopardize the intended purpose of SARS-CoV-2 vaccine. Also, the schedule and alternative vaccine for the second dose and the role early use of non-immunosuppressive treatment like Thrombopoietin receptor agonist are unclear. While the universal immunization program needs to continue, vigilance to the occurrence of severe thrombocytopenia due to vaccination is needed.

[1] Kohli R, Chaturvedi S. Epidemiology and Clinical Manifestations of Immune Thrombocytopenia. Hamostaseologie. 2019; 39(3):238-249.
[2] Bhattacharjee S, Banerjee M. Immune Thrombocytopenia Secondary to COVID-19: a Systematic Review. SN Compr Clin Med. 2020; 2(11):2048-2058.
[3] Giordano P, Cascioli S, Lassandro G, Marcellini V, Cardinale F, Valente F, et al. B-cell hyperfunction in children with immune thrombocytopenic purpura persists after splenectomy. Pediatr Res. 2016; 79(2):262-70.
[4] Yokomichi H, Tanaka-Taya K, Koshida R, Nakano T, Yasui Y, Mori M, et al. Immune thrombocytopenic purpura risk by live, inactivated and simultaneous vaccinations among Japanese adults, children and infants: a matched case-control study. Int J Hematol. 2020; 112(1):105-114.
[5] Simpson CR, Shi T, Vasileiou E, Katikireddi SV, Kerr S, Moore E, et al. First-dose ChAdOx1 and BNT162b2 COVID-19 vaccines and thrombocytopenic, thromboembolic and hemorrhagic events in Scotland. Nat Med. 2021; 27(7):1290-1297.
[6] Pasin F, Calabrese A, Pelagatti L. Immune thrombocytopenia following COVID-19 mRNA vaccine: casuality or causality? Intern Emerg Med. 2021; 1–3.
[7] Arashkia A, Jalilvand S, Mohajel N, Afchangi A, Azadmanesh K, Salehi-Vaziri M, et al. SARS CoV-2 Rapid Response Team of Pasteur Institute of Iran (PII). Severe acute respiratory syndrome-coronavirus-2 spike (S) protein based vaccine candidates: State of the art and future prospects. Rev Med Virol. 2021; 31(3):e2183.
[8] Watanabe Y, Mendonça L, Allen ER, Howe A, Lee M, Allen JD, et al. Native-like SARS-CoV-2 spike glycoprotein expressed by ChAdOx1 nCoV-19/AZD1222 vaccine. ACS Cent Sci. 2021; 7(4):594-602.
[9] Othman M, Labelle A, Mazzetti I, Elbatarny HS, Lillicrap D. Adenovirus-induced thrombocytopenia: the role of von Willebrand factor and P-selectin in mediating accelerated platelet clearance. Blood. 2007; 109(7):2832-9.
[10] Papp KA, Haraoui B, Kumar D, Marshall JK, Bissonnette R, Bitton A, et al. Vaccination Guidelines for Patients With Immune-Mediated Disorders on Immunosuppressive Therapies. J Cutan Med Surg. 2019; 23(1):50-74.
Files
IssueVol 8 No 2 (2022): Spring QRcode
SectionCase Report(s)
DOI https://doi.org/10.18502/aacc.v8i2.9160
Keywords
Immune thrombocytopenic purpura SARS-CoV-2 Thrombocytopenia Thrombopoietin agonist.

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Samprathi A, Sarada P, Dalal H. Re-Visiting Immune Thrombocytopenia with Covid-19 Vaccination: A Case Report. Arch Anesth & Crit Care. 2022;8(2):166-168.