Real‐world, single‐center experience of SARS‐CoV‐2 vaccination in immune thrombocytopenia

• Published in: Journal of thrombosis and haemostasis Vol. 20; no. 6; pp. 1476 - 1484
• Main Authors: Woolley, Philippa, Tailor, Anish, Shah, Raakhee, Westwood, John‐Paul, Scully, Marie
• Format: Journal Article
• Language: English
• Published: England Elsevier Limited 01-06-2022; John Wiley and Sons Inc
• Subjects: Adult; COVID-19 - prevention & control; COVID-19 Vaccines - adverse effects; COVID‐19; Diagnosis; Humans; Idiopathic thrombocytopenic purpura; immune thrombocytopenia; Immunization; Original; Patients; PLATELETS; Purpura, Thrombocytopenic, Idiopathic - diagnosis; Purpura, Thrombocytopenic, Idiopathic - epidemiology; Recurrence; relapse; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Vaccination; Vaccination - adverse effects; COVID-19; relapse; immune thrombocytopenia; platelets; vaccination
• ISSN: 1538-7933; 1538-7836; 1538-7836
• DOI: 10.1111/jth.15704

Background
Immune thrombocytopenic purpura (ITP) relapse following vaccination remains poorly reported in the adult population.
Objectives
This report details real world data from the largest single‐center cohort of ITP relapse following severe acute respiratory syndrome (SARS‐CoV‐2) vaccination.
Methods
The vaccination status of 294 patients under active follow‐up was reviewed. A total of 17 patients were identified resulting in an incidence of ITP relapse following SARS‐CoV‐2 vaccination in this cohort of 6.6% and an incidence of newly diagnosed ITP following SARS‐CoV‐2 vaccination of 1.4%.
Results
Patients were noted to develop marked deviation of platelet count from baseline following vaccination (P =< .0001). Fourteen patients had a prior diagnosis of ITP and median follow‐up following diagnosis was 4 years (range 0–45 years). Days from vaccination to presentation ranged from 2–42 (median 14) and the follow‐up period was 34 weeks. Fifteen patients (88%) presented with symptoms and all 17 patients developed symptoms during the follow‐up period. Nine patients (53%) received a second dose of vaccine during the follow‐up period with seven patients (78%) requiring therapeutic support to facilitate second vaccination. Decision to treat patients was multi‐factorial and aimed at decreasing bleeding symptoms and obtaining a platelet count >30 × 109/L. Sixteen patients (94%) required therapeutic intervention and at the end of the follow‐up period, four patients (24%) remained unresponsive to treatment with a platelet count <30 × 109/L.
Conclusion
Vaccination of ITP patients continues to have important clinical benefit; however, recommendations for patients who relapse remain lacking. This report outlines the real‐world patient outcomes in the era of widespread SARS‐CoV‐2 vaccination.