Severe immune thrombocytopenic purpura after SARS-CoV-2 vaccine

Katherine M. Cooper, Bradley Switzer


Immune thrombocytopenic purpura (ITP) is a rare hematologic condition through to affect 3.3 in 100,000 adults per year in the United States. Many cases of immune thrombocytopenia are diagnosed incidentally with laboratory tests that reveal low platelet count, without a clear cause. However, when platelet counts are very low, patients may show signs of bleeding. Here we present the case of a 24-year-old female with mucocutaneous bleeding ten days after receiving her first dose of SARS-CoV-2 vaccine, who was subsequently found to have severe thrombocytopenia. Extensive work up for new thrombocytopenia was unremarkable suggesting a diagnosis of ITP, potentially secondary to vaccination. Empiric treatment with glucocorticoids was initiated without response prompting the use of intravenous immunoglobulin G.  The patient was discharged on hospital day five with a platelet count over 20,000 platelets per microliter.  In summary, ITP is a potential sequela of the SARS-CoV-2 vaccine, and otherwise healthy young individuals may be at risk for hematologic side effects.


Coronavirus vaccine; thrombocytopenia; immune reactions

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Zufferey A, Kapur R, Semple JW. Pathogenesis and therapeutic mechanisms in immune thrombocytopenia (ITP). J Clin Med 2017; 6(2):16.

Terrell DR, Beebe LA, Vesely SK, Neas BR, Segal JB, George JN. The incidence of immune thrombocytopenia in children and adults: A critical review of published reports. Am J Hematol 2010; 85(3):174-180.

Abrahamson PE, Hall SA, Feudjo‐Tepie M, Mitrani‐Gold FS, Logie J. The incidence of idiopathic thrombocytopenic purpura among adults: a population‐based study and literature review. Eur J Haematol 2009; 83(2):83-89.

Provan D, Stasi R, Newland AC, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood 2010; 115(2):168-186.

Cines DB, Bussel JB. How I treat idiopathic thrombocytopenic purpura (ITP). Blood 2005;106(7):2244-2251.

ITP A. Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy. Br J Haematol 2003; 120(1):574-596.

Lee EJ, Cines DB, Gernsheimer T, et al. Thrombocytopenia following Pfizer and Moderna SARS-CoV-2 vaccination. Am J Hematol 2021; 96(5):534-537 doi: 10.1002/ajh.26132. Epub 2021 Mar 9.

Choi HS, Ji MH, Kim SJ, Ahn HS. Platelet count recovery after intravenous immunoglobulin predicts a favorable outcome in children with immune thrombocytopenia. Blood res 2016; 51(2):95.

Guimaraes LE, Baker B, Perricone C, Shoenfeld Y. Vaccines, adjuvants and autoimmunity. Pharmacol Res 2015; 100:190-209.

Perricone C, Ceccarelli F, Nesher G, et al. Immune thrombocytopenia (ITP) associated with vaccinations: a review of reported cases. Immunol Res 2014; 60(2-3):226-235.

Polack FP, Thomas SJ, Kitchin N, et al. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. N Engl J Med 2020; 383(27):2603-2615.

Tarawneh O, Tarawneh H. Immune thrombocytopenia in a 22‐year‐old post Covid‐19 vaccine. Am J Hematol 2021; 96(5):E133-E134. doi: 10.1002/ajh.26106.


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ISSN: 2360-6975