Severe case of refractory immune thrombocytopenic purpura requiring splenectomy after the COVID-19 vaccine

Abstract

Immune thrombocytopenic purpura (ITP) is an autoimmune disorder caused by autoantibodies against platelet antigens resulting in platelet destruction and inhibition of platelet production. Occasionally, an inciting event such as a virus or vaccination can precipitate ITP. Several cases of ITP have been reported after the BTN162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) SARS-CoV-2 (COVID-19) vaccines. All reported cases of post-vaccination ITP have resolved with medical therapy until this case.A man in his mid-20s developed bleeding from ITP 2 weeks after receiving the second dose of the Pfizer SARS-CoV-2 vaccine. All inpatient medical treatment attempts failed. On hospital day 40, a splenectomy was performed and he ultimately recovered and was discharged.Awareness of potential vaccination side effects is a fundamental element of refining and improving patient safety. This case illustrates that given the right circumstances, serious refractory ITP can develop in response to the second dose of the Pfizer SARS-CoV-2 vaccine.

Immune Thrombocytopenia After COVID-19 Vaccine Requiring Splenectomy: A Case Report and Review of the Literature

“…However, familial predisposition may not be a consistent risk factor for vaccine-induced ITP, as our case did not have a family history of any autoimmune diseases. Unlike the previously reported cases where symptoms emerged one to two weeks after the second dose of the COVID-19 vaccine [ 5 - 7 ], our case experienced symptoms one week after the first dose and responded well to initial ITP management.…”

“…Table 1 summarizes the reported cases in the literature. None of the documented cases had pre-existing ITP, although two patients had a family history of autoimmune disease or ITP in a family member [ 5 , 7 ]. This suggests a possible genetic predisposition to developing ITP.…”

“…We present a unique case of severe and refractory ITP requiring intensive treatment, including splenectomy. As of date, there have been only three cases in the literature of ITP post COVID-19 vaccine requiring splenectomy [ 5 - 7 ]. We present a case of a patient who developed severe refractory ITP two weeks after receiving the COVID-19 vaccine.…”

Antibodies against Platelet Glycoproteins in Clinically Suspected VITT Patients

“…Starting in June 2020, the Dutch ITP guideline required testing for platelet-autoantibodies in the MAIPA to support an ITP diagnosis [ 37 ], which likely resulted in an increase in platelet-autoantibody tests in the second half of 2020. Requests for platelet-autoantibody tests continued to increase in the following years, which is most likely related to the start of the COVID-19 vaccination strategy in January 2021 and the concomitant clinical awareness for serious adverse effects [ 27 , 28 , 38 ]. Although the increase in confirmed COVID-19 infections in January/February 2022 [ 39 ] appears to coincide with the continuous increase of positive platelet-autoantibody tests, more data on whether the patients in our cohort experienced COVID-19 infections need to be investigated in subsequent studies.…”

Quantitative data do not coincide with meaningful insights: Reply to Shahreedhan et al.

“…We agree with this final conclusion as reported by our report and by several papers regarding AIH triggered by influenza vaccination. 3 Surely, both the mRNA and deactivated adenovirus COVID-19 vaccines could cause an immune pathways dysregulation with autoimmunity disorders onset, such as the immune thrombocytopenic purpura, 4 Guillain-Barre syndrome 5 and others.…”