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. 2023 Jan;7(1):100009.
doi: 10.1016/j.rpth.2022.100009. Epub 2022 Dec 13.

Immune thrombocytopenia and COVID-19 vaccination: Outcomes and comparisons to prepandemic patients

Philip Young-Ill Choi  1   2 , Danny Hsu  3   4 , Huyen Anh Tran  5 , Chee Wee Tan  6   7 , Anoop Enjeti  8 , Vivien Mun Yee Chen  9 , Eileen Merriman  10 , Agnes S M Yong  11   12 , Jock Simpson  13 , Elizabeth Gardiner  2 , Nicolas Cherbuin  14 , Jennifer Curnow  15   16 , Dominic Pepperell  17 , Robert Bird  18
Affiliations

Immune thrombocytopenia and COVID-19 vaccination: Outcomes and comparisons to prepandemic patients

Philip Young-Ill Choi et al. Res Pract Thromb Haemost. 2023 Jan.

Abstract

Background: Immune thrombocytopenia (ITP) has been reported following COVID-19 vaccination. After index case fatalities, there was concern among patients both with and without a prior history of ITP in Australia.

Objectives: To describe treatment outcomes of ITP after COVID-19 vaccination and compare relapsed vs historical pre-COVID-19 ITP cohorts.

Methods: We collected ITP cases in Australia within 6 weeks of receiving any COVID-19 vaccination as part of primary vaccination (up to October 17, 2021). Second, we reviewed platelet charts in a historical ITP cohort to determine whether platelet variability was distinct from relapsed ITP after vaccination.

Results: We report on 50 patients (37 de novo, 13 relapsed ITP) vaccinated from March 22, 2021, to October 17, 2021. Although there was 1 fatality, bleeding was otherwise mostly minor: (70% WHO bleeding grade <2). De novo ITP was more likely after AstraZeneca ChAdOx1 nCoV-19 (89%) than Pfizer BNT162b2 (11%). Most patients responded quickly (median, 4 days; complete response, 40 of 45 [89%]). In the historical cohort, only 6 of 47 patients exhibited platelet variability (>50% decrease and platelets <100 × 109/L), but median platelet nadir was significantly higher than vaccination relapse (27 vs 6 × 109/L, P =.005).

Conclusion: ITP was more frequently reported after AstraZeneca ChAdOx1 nCoV-19 than Pfizer BNT162b2 vaccination. Standard ITP treatments remain highly effective for de novo and relapsed ITP (96%). Although thrombocytopenia can be severe after vaccination, bleeding is usually mild. Despite some sampling bias, our data do not support a change in treatment strategies for patients with ITP after vaccination.

Keywords: BNT162 vaccine; COVID-19 vaccines; ChAdOx1 nCov-19; immune thrombocytopenia; treatment outcome; vaccination.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Flow diagram of recruitment, classification, and comparison with historical cohort. ITP, immune thrombocytopenia.
Figure 2
Figure 2
Platelet responses were higher in patients who presented with ITP later after vaccination (14 days or more), than those presenting earlier (<14 days) (median 73 vs 138 ×109/L, P =.03∗). ITP, immune thrombocytopenia.
Figure 3
Figure 3
(A) ITP after ChAd vaccinations were more commonly associated with de novo presentations (OR 7.1, 95% CI: 1.7 to 26, p = 0.01∗) and first dose vaccinations (OR 6.0, 95% CI: 1.4-26, P =.04∗) compared with (B) ITP after BNT vaccinations. ITP, immune thrombocytopenia.
Figure 4
Figure 4
Platelet counts for patients whose ITP relapsed after vaccination: platelets returned to pre-COVID-19 vaccination levels. ITP, immune thrombocytopenia.
Figure 5
Figure 5
Platelet nadirs in ITP relapse after COVID-19 vaccination were significantly lower than nadirs in “unstable” chronic ITP patients in the historical cohort (median 27 vs 6 × 109/L, P =.005∗∗). ITP, immune thrombocytopenia.
See this image and copyright information in PMC

References

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