Sex: M
Vaccine: COVID19
Symptoms: Influenza B virus test, Physical examination, Platelet count, Proctitis, Rectal examination
Clinical narrative: immune thrombocytopenia; proctitis; This is a literature-spontaneous report from Experimental Hematology and Oncology, 2021, volume 10 (1), DOI: 10.1186/s40164-021-00235-0, entitled "COVID-19 vaccination associated severe immune thrombocytopenia". This reporter reported 2 reports; this is the 2 of 2 reports. A 67-years-old male patient received first dose of bnt162b2 (Pfizer-Biontech COVID-19 Vaccine, batch/lot number: not reported), via an unspecified route of administration on an unspecified date as single dose for COVID-19 immunisation. The patient reported that he had received the first dose of Pfizer- BioNTech COVID-19 vaccine two days prior to admission. The patient medical history included seizure disorder, atrial fibrillation, chronic ITP in remission and no prior exposure to heparin, was seen in ED with symptoms of generalized weakness and melena and splenectomy. Concomitant medications were not reported. On an unspecified date, the patient experienced immune thrombocytopenia. The patient denied any recent flares of ITP and he had normal platelet counts in the range of 140-160 x 109/ L since undergoing splenectomy 4 years ago. Physical exam showed generalized petechiae. Rectal exam revealed black tarry stools. Rest of the physical exam was unremarkable. A CBC showed a platelet count of 2 x 109/ L. Rest of the blood counts and red cell indices were normal. Peripheral blood film did not show platelet clumping or schistocytes. Hepatitis C and HIV serology was non-reactive. Viral respiratory panel including influenza A and B, RSV and COVID-19 was negative. Coagulation profile was normal. The patient received two units of single-donor platelet transfusion without any significant improvement in platelet count, however melena stopped. CT of the head and chest were unremarkable while the CT of the abdomen showed mild rectal wall thickening with fat stranding suspicious of proctitis. The patient received IVIG 1 g/kg/day for 2 consecutive days and oral dexamethasone 40 mg/day for 4 consecutive days. He had a gradual improvement in platelet count which eventually normalized in about a week after initiation of therapy. The patient was advised to defer the second dose of COVID-19 vaccine due to the occurrence of severe thrombocytopenia. The patient received treatment with corticosteroids +- IVIG. If the treatments (IVIG and/or steroids) utilized in our cases were not effective, and the platelet count remained very low, it would then be reasonable to escalate therapy to include a thrombopoietic agent, and potentially vinca alkaloids, depending upon response. The outcome of the adverse event was recovered on an unknown date.  Case comment: Based on the information available in narrative, a possible contributory role of the suspect vaccine bnt162b2 or Comirnaty in triggering the onset of immune thrombocytopenia and proctitis cannot be excluded. But also consider medical history of chronic ITP in remission. The impact of this report on the benefit/risk profile of the Pfizer product was evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.; Sender's Comments: Linked Report(s) : US-PFIZER INC-202100941120 same article/suspect/event, different patient