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Immune thrombocytopenia secondary to COVID-19 vaccine: a rare case
Vox Sanguinis ; 117(SUPPL 1):264, 2022.
Article in English | EMBASE | ID: covidwho-1916367
ABSTRACT

Background:

SARS-CoV-2 associated COVID-19 was declared as pandemic in March'20.It led to accelerated scientific development leading to production of several vaccines.In India,first vaccine used was ChAdOx1 nCoV-19.Reports of pro-thrombotic and hemorrhagic complications with it are there but isolated immune thrombocytopenia is rare.We are reporting secondary immune thrombocytopenia (ITP) possibly attributed to COVID-19 vaccine.

Aims:

A 21-years female came to General Medicine with complaints of weakness,rashes all over body,bleeding from gums, menorrhagia and reddish discoloration of urine.She had history of COVID-19 vaccination 2 days back.On examination, she was mildly febrile, showed multiple pin-point petechial haemorrhages over face,abdomen,both limbs and sub-conjunctival haemorrhage with no complaints of headache/visual disturbances/pain abdomen/respiratory distress.Systemic examination showed no significant findings.She had no previous history of bleeding/drug intake/no family history of bleeding or any other significant conditions.

Methods:

Lab investigations showed Hb8.6gm%,TLC14,400/cmm, platelet counts10,000/cmm.Peripheral blood smear showed normocytic normochromic RBC with leucocytosis and marked thrombocytopenia with absent hemoparasites.Urine examination showed numerous RBCs with no pus cells.S. electrolytes were normal, SGOT/ SGPT were mildly increased, total proteins were normal.S. bilirubin,urea,creatinine were normal.HIV,HCV,HBsAg,CMV IgM were negative.To rule out connective tissue disorders,ANA and dsDNA were performed which came negative.Her USG abdomen and CTchest were normal.COVID-19 RT-PCR was negative.ITP secondary to COVID-19 vaccination was suspected.

Results:

She was started with i.v. methylprednisolone pulse therapy for 3 days and IVIG for 2 days and also received trenexamic acid for menorrhagia.She received 6 units of random donor platelets which improved platelet count.After haematology consultation,oral prednisolone for 7 days with alternate day platelet count monitoring was started.She improved symptomatically with no new bleeding.She was discharged after 10 days with an advice to follow up. Summary/

Conclusions:

ITP is autoimmune disorder with autoantibodies against platelets,more common in females.It is usually idiopathic,but occasionally secondary to viral infections/vaccinations. Incidence of vaccine associated ITP is <1%.Previously reported with various vaccines like influenza,measles,mumps,rubella,etc.Vaccine induced thrombotic thrombocytopenia (VITT) with COVID-19 vaccine has been well documented,but ITP is rare.VITT is usually characterized by major thrombotic episodes at unusual locations like sagittal sinus,splanchnic circulation,etc. with visual, neurological and abdominal features.No such findings seen in our case.Although she had low platelet count,yet mild symptoms which improved with conservative management with steroid and IVIG.Although we could not establish a temporal link;yet based on findings,ITP secondary to COVID-19 vaccine could not be ruled out.It is important to be aware of this complication as although rare,it could lead to significant morbidity and fatal bleed if not managed promptly. Steroids and IVIG is highly effective in ITP irrespective of cause.However,more investigations need to be done to establish a temporal relationship with COVID-19 vaccine. Nevertheless,occurrence of ITP should not be a deterrent in vaccination,though caution should be exerted in history of thrombocytopenia.
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Full text: Available Collection: Databases of international organizations Database: EMBASE Topics: Vaccines Language: English Journal: Vox Sanguinis Year: 2022 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Topics: Vaccines Language: English Journal: Vox Sanguinis Year: 2022 Document Type: Article