Immune thrombocytopenic purpura following mRNA-SARS-CoV-2 vaccination: a case report

Authors

DOI:

https://doi.org/10.15649/cuidarte.3799

Keywords:

COVID-19, SARS-CoV-2, mRNA Vaccines, Immune Thrombocytopenic Purpura, Platelets

Abstract

Highlights

  • Cases of autoimmune diseases have been registered after vaccination with mRNA vaccines (BNT162b2 or mRNA-1273).
  • A case of immune thrombocytopenic purpura following mRNA-SARS-CoV-2 without any previous reports of thrombocytopenia or other hematologic disorders is presented.
  • The thrombocytopenia persisted and progressed to a chronic non-bleeding condition two years after the first vaccine dose administration, with episodes of temporary recovery of platelet counts.
  • Considering that the incidence of secondary ITP and other hematological disorders has significantly increased due to COVID-19 vaccination, a post-vaccination hemogram check could be a useful and inexpensive follow-up measure.

Introduction: Herein, it is presented a case report of a Colombian adult male patient, without any previous report of thrombocytopenia or hematological disorders, who developed a mild and chronic paucisymptomatic immune thrombocytopenic purpura, a rare complication following SARS-CoV-2 m-RNA. To the best of our knowledge, this represents the first documented case in Colombia of immune thrombocytopenic purpura associated with mRNA vaccines (BNT162b2 or mRNA-1273), with a comprehensive 2-year clinical follow-up. Case Description: The patient received the initial and second doses of the mRNA BNT162b2 vaccine in June 2021, the first booster dose in November 2021 (mRNA-1273), and the second booster dose (mRNA BNT162b2) in June 2022. Thrombocytopenia (<100 x109 platelets/L, which is the criterion to define immune thrombocytopenic purpura) was documented after the second vaccination dose and both boosters, and it improved after corticosteroid therapy. However, cycling thrombocytopenia persisted until the clinical follow-up in August 2023, with platelet count ranging from 57 to 191 x109 platelets/L (mean: 103 x109 platelets/L). Conclusion:  Given that secondary immune thrombocytopenic purpura can occur following SARS-CoV-2 mRNA vaccination, systematic research to identify risk factors associated with immune thrombocytopenic purpura due to COVID-19 immunization should be conducted.

How to cite this article: Lozada Ramos Heiler, Martínez-Vega Ruth Aralí, García Liliana Torcoroma. Immune thrombocytopenic purpura following mRNA-SARS-CoV-2 vaccination: A case report. Revista Cuidarte. 2024;15(2):e3799.     https://doi.org/10.15649/cuidarte.3799

Author Biographies

Heiler Lozada Ramos, Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Instituto de Investigación Masira, Bucaramanga, Colombia. Universidad Santiago de Cali, Escuela de Medicina, Cali, Colombia.

Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Instituto de Investigación Masira, Bucaramanga, Colombia. Universidad Santiago de Cali, Escuela de Medicina, Cali, Colombia. Departamento de Postgrado en Enfermedades Infecciosas, Bucaramanga, Colombia.

Ruth Aralí Martínez-Vega, Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Instituto de Investigación Masira, Bucaramanga, Colombia.

Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Instituto de Investigación Masira, Bucaramanga, Colombia. MD, MSc, PhD. Escuela de Medicina, Universidad de Santander. Colombia.

Liliana Torcoroma García, Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Instituto de Investigación Masira, Bucaramanga, Colombia.

Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Instituto de Investigación Masira, Bucaramanga, Colombia. Escuela de Medicina, Bucaramanga, Colombia.

References

Instituto Nacional de Salud. Situación COVID-19. Boletín Epidemiológico Semanal. 2023;52:17. https://doi.org/10.33610/23576189.2023.52

World Health Organization 2023 data.who.int. WHO Coronavirus (COVID-19) dashboard >Vaccines [Internet]. Ginebra: WHO. [cited 2024 May 11]. Available from: https://data.who.int/dashboards/covid19/vaccines

Alshammari F, Abuzied Y, Korairi A, Alajlan M, Alzomia M, AlSheef M. Bullous pemphigoid after the second dose of mRNA- (Pfizer-BioNTech) Covid-19 vaccine: A case report. Ann Med Surg (Lond). 2022;75:103420. https://doi.org/10.1016/j.amsu.2022.103420

Hagihara M, Uchida T, Inoue M, Ohara S, Imai Y. Severe thrombocytopenia after COVID-19 mRNA vaccination. Rinsho Ketsueki. 2021;62(12):1684-1687. https://doi.org/10.11406/rinketsu.62.1684

King ER, Towner E. A Case of Immune Thrombocytopenia After BNT162b2 mRNA COVID-19 Vaccination. Am J Case Rep. 2021;22:e931478. https://doi.org/10.12659/AJCR.931478

Leone MC, Canovi S, Pilia A, Casali A, Depietri L, Fasano T, et al. Four cases of acquired hemophilia A following immunization with mRNA BNT162b2 SARS-CoV-2 vaccine. Thromb Res. 2022;211:60-62. https://doi.org/10.1016/j.thromres.2022.01.017

Sato K, Anayama M, Sumi M, Kobayashi H. Immune thrombocytopenia after BNT162b2 mRNA COVID-19 vaccination. Rinsho Ketsueki. 2021;62(12):1688-1693. https://doi.org/10.11406/rinketsu.62.1688

Kuter DJ. The treatment of immune thrombocytopenia (ITP): focus on thrombopoietin receptor agonists. Ann Blood. 2021;6:7. http://dx.doi.org/10.21037/aob-21-23

Neylon AJ, Saunders PW, Howard MR, Proctor SJ, Taylor PR, Northern Region Haematology Group. Clinically significant newly presenting autoimmune thrombocytopenic purpura in adults: a prospective study of a population-based cohort of 245 patients. Br J Haematol. 2003;122:966-74. https://doi.org/10.1046/j.1365-2141.2003.04547.x

Lo E, Deane S. Diagnosis and classification of immune-mediated thrombocytopenia. Autoimmun Rev. 2014;13:577-83. https://doi.org/10.1016/j.autrev.2014.01.02

Lozada Ramos H, Martínez-Vega R, García LT. A case report of de novo immune thrombocytopenic purpura (ITP) following COVID-19-mRNA vaccination: 2-year clinical follow up. Mendeley Data, V2. 2024. https://doi.org/10.17632/wvdxt4r9yw.2

Waxman JG, Makov-Assif M, Reis BY, Netzer D, Balicer RD, Dagan N, et al. Comparing COVID-19-related hospitalization rates among individuals with infection-induced and vaccine-induced immunity in Israel. Nat Commun. 2022;13:2202. https://doi.org/10.1038/s41467-022-29858-5

Alameh MG, Weissman D, Pardi N. Messenger RNA-based vaccines against infectious diseases. Yu D, Petsch B. (eds) mRNA Vaccines. Curr Top Microbiol Immunol. 2022;440:111-145. https://doi.org/10.1007/82_2020_202

Sharif N, Alzahrani KJ, Ahmed SN, Dey SK. Efficacy, immunogenicity, and safety of COVID-19 vaccines: a systematic review and meta-analysis. Front Immunol. 2021;12:714170. https://doi.org/10.3389/fimmu.2021.714170

Cooper N, Ghanima W. Immune thrombocytopenia. N Engl J Med. 2019;381:945-955. https://doi.org/10.1056/NEJMcp1810479

Sivaramakrishnan P, Mishra M. Vaccination-associated immune thrombocytopenia possibly due to ChAdOx1 nCoV-19 (Covishield) coronavirus vaccine. BMJ Case Rep. 2022;15:e249237. https://doi.org/10.1136/bcr-2022-249237

Bidari A, Asgarian S, Pour Mohammad A, Naderi D, Anaraki SR, Gholizadeh Mesgarha M, et al. Immune thrombocytopenic purpura secondary to COVID‐19 vaccination: A systematic review. Eur J Haematol. 2023;110:335-353. https://doi.org/10.1111/ejh.13917

Saluja P, Amisha F, Gautam N, Goraya H. A Systematic Review of Reported Cases of Immune Thrombocytopenia after COVID-19 Vaccination. Vaccines. 2022;10(9):1444. https://doi.org/10.3390/vaccines10091444

Malayala SV, Mohan G, Vasireddy D, Atluri P. Purpuric rash and thrombocytopenia after the mRNA-1273 (Moderna) COVID-19 vaccine. Cureus. 2021;13(3):e14099. https://doi.org/10.7759/cureus.14099

Inagaki N, Kibata K, Tamaki T, Shimizu T, Nomura S. Prognostic impact of the mean platelet volume/platelet count ratio in terms of survival in advanced non-small cell lung cancer. Lung Cancer. 2014;83(1):97-101. https://doi.org/10.1016/j.lungcan.2013.08.020

O'Shea KM, Aceves SS, Dellon ES, Gupta SK, Spergel JM, Furuta GT, et al. Pathophysiology of Eosinophilic Esophagitis. Gastroenterology. 2018;154(2):333-345. https://doi.org/10.1053/j.gastro.2017.06.065

Mohamed I, Abbas R, Amer A, Hassan E. Platelet/lymphocyte ratio (PLR) predictive value in immune thrombocytopenic purpura patients. Ain Shams Med J. 2023;74(1):13-20. https://doi.org/10.21608/ASMJ.2023.298369

Wang LH, Chen C, Wang Q, Song J, Cao J, Guo PX. Platelet to Lymphocyte Ratio and Glucocorticoid Resistance in Newly Diagnosed Primary Immune Thrombocytopenia: A Retrospective Cohort Study. Med Sci Monit. 2019;25:7321-7331. https://doi.org/10.12659/MSM.916907

Augène E, Lareyre F, Chikande J, Guidi L, Ballaith A, Bossert JN, et al. Platelet to lymphocyte ratio as a predictive factor of 30-day mortality in patients with acute mesenteric ischemia. PLoS One. 2019;14(7):e0219763. https://doi.org/10.1371/journal.pone.0219763

Downloads

Published

2024-07-04

How to Cite

1.
Lozada Ramos H, Martínez-Vega RA, García LT. Immune thrombocytopenic purpura following mRNA-SARS-CoV-2 vaccination: a case report. Revista Cuidarte [Internet]. 2024 Jul. 4 [cited 2024 Jul. 20];15(2). Available from: https://revistas.udes.edu.co/cuidarte/article/view/3799

Altmetrics

Downloads

Download data is not yet available.

Most read articles by the same author(s)