Immune Thrombocytopenia Post Covishield Vaccination

ABSTRACT

Introduction: Immune thrombocytopenia (ITP) after COVID-19vaccination is being increasingly reported worldwide.Aims &Objectives: We present five cases of ITP following theAstraZeneca Covishield vaccination.Materials &Methods: We retrospectively collected data on patientspresenting with immune thrombocytopenia post-Covishield vaccination at the Department of Hematology, AIIMS, New Delhi.Result: 5 patients diagnosed with ITP followingAstraZeneca Covishieldvaccination were included. Themedian age at diagnosis in our cohortwas44 years (21-67 years). Of the 5 patients, 2 are female and 3 aremale. Allof them received the Astrazeneca Covishield vaccine. Most of thepatients presented with petechiae and wet purpura with the onset ofsymptoms between 7-20 days (median 15 days) post-vaccination. All ofthese patients had severe thrombocytopenia at presentationwith amedianplatelet count of 7 × 109/l (range 1-14 × 109/l). Anti PF4 antibodytesting was done in two patients which were negative.Therapy details include IVIG (3), steroids (4), eltrombopag (2),azathioprine (1), and platelet transfusions (2). Of these, two patientshad no response to first-line therapies. One patient did not respond toIVIG, steroids, azathioprine, and subsequently developed anintracranial bleed. He was managed with platelet transfusions, IVIG,steroids, and eltrombopag. His platelet counts have stabilized at50 × 109/l and he did not have further bleeding manifestations. Atthe last follow-up, 80% (n = 4) of our patients have achieved aresponse.Conclusions: Immune thrombocytopenia is being increasingly recognized post-COVID vaccination. All our patients had severethrombocytopenia requiring therapy. The question of whether thesecases are actually primary ITP coinciding with the administration ofthe vaccine or ITP secondary to vaccination remains unanswered.Additional surveillance is needed to determine the true incidence ofCOVID-19 vaccine-induced ITP.