Mass vaccination campaigns are being run all over the globe to combat the ongoing COVID-19 pandemic. There have been several reports of immune thrombocytopenic purpura (ITP) occurrence following COVID-19 vaccination. However, ITP due to the Pfizer-BioNTech vaccine has been rarely reported, and a causal link has not been identified. The pathophysiology behind immune thrombocytopenia is similar to heparininduced thrombocytopenia. The management is also similar to other secondary immune thrombocytopenia. We present a case of a 67-year old female diagnosed with immune thrombocytopenia following Pfizer-BioNTech vaccination. The treatment was resistant to high-dose steroids, intravenous immunoglobulin (IVIG), and rituximab and eventually responded to a thrombopoietin-stimulating agent.

Aim: To study the prevalence of induction of labor and obstetric and neonatal outcome among delivery cases in the maternity unit of a tertiary care center. Methods: This is a prospective cross-sectional study conducted on pregnant ladies presenting to maternity unit of Shree Birendra Hospital, Chhauni over a period of six months from March to August 2017. All pregnant ladies in labor during the study period were enrolled. Induction of labor, mode of delivery, perinatal outcome (gestational age at delivery, birth weight), and maternal complications if any were recorded. Results: Among 497 deliveries in the study period, induction of labor was performed in 117 (23.5%) cases with post-date pregnancy being the most common indication. Induction was successful with vaginal deliveries in 82(70.1%) cases, while in the rest, IOL failed. Among the induced cases, 17 (14.5%) neonates had poor APGAR at 5 minutes and there was significant association of IOL with low APGAR. There was normal post-natal recovery in 108 (92.3%) induced cases while 9 (7.7%) cases developed some maternal complications. IOL has no significant association with maternal and neonatal complications or perineal injury (p>0.05). Conclusions: The prevalence of induction in this center is slightly higher than other centers. The IOL has significant association with low APGAR at 5 minutes but no significant association with the neonatal and maternal complications.

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Aplastic anemia (AA) is a severe but rare hematologic condition associated with hematopoietic failure leading to decreased or total absent hematopoietic precursor cells in the bone marrow. AA presents at any age with equal distribution among gender and race. There are three known mechanisms of AA: direct injuries, immune-mediated disease, and bone marrow failure. The most common etiology of AA is considered to be idiopathic. Patients usually present with non-specific findings, such as easy fatigability, dyspnea on exertion, pallor, and mucosal bleeding. The primary treatment of AA is to remove the offending agent. In patients in whom the reversible cause was not found, patient management depends on age, disease severity, and donor availability. Here, we present a case of a 35-year-old male who presented to the emergency room with profuse bleeding after a deep dental cleaning. He was found to have pancytopenia on his laboratory panel and had an excellent response to immunosuppressive therapy.