Sex: M
Vaccine: COVID19
Symptoms: Immune thrombocytopenia, Platelet count
Clinical narrative: WORSENED IMMUNE THROMBOCYTOPENIA; This spontaneous report was received from literature: Exacerbation of immune thrombocytopenia following Covid-19 vaccination. This report concerned a 60 year old male patient of unspecified race and ethnic origin. The objective of this study was prospective analysis of all of immune thrombocytopenia (ITP) patients after 12-JAN-2021 to assess the frequency of worsening ITP symptoms and exacerbation of thrombocytopenia in those who chose to receive COVID-19 vaccination. The duration period of study was between 12-JAN-2021 and 01-MAY-2021. In the study, 52 consecutive patients who received COVID-19 vaccination were identified and followed. The patients were advised to obtain platelet counts 1-7 days before and 3-14 days after vaccination and assessed for exacerbation of their thrombocytopenia and clinical signs of bleeding after vaccination.  The patient's height, and weight were not reported. The patient's past medical history included splenectomy (had multiple courses of rituximab), and concurrent conditions included immune thrombocytopenia (had since 16 years). The patient had multiple prior severe relapses every 3-5 years often lasted for months. The patient experienced severe relapse of immune thrombocytopenia when treated with meningococcal vaccine for prophylactic vaccination in past. The patient was in complete remission for 3 years. The patient's platelet count prior to vaccination was 270 X 10*9/L. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) 1 total, dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported.  Five days after the vaccination, the patient experienced a worsened immune thrombocytopenia. The patient had petechiae, ecchymoses, epistaxis and oral blood blisters. Five days after vaccine, platelets were 7 X 10*9/L with epistaxis. The lowest platelet count after the vaccination was 1 X 10*9/L. The patient was treated with prednisone, intravenous immunoglobulin, rituximab and romiplostim. It had been 33 days until platelet count were greater than 30 X 10*9/L. Laboratory data (dates unspecified) included: Platelet count (NR: not provided) 1 X 10*9/L, 7 X 10*9/L, greater than 30 X 10*9/L, 270 10*9/L.  The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of worsened immune thrombocytopenia was not reported. In conclusion, the results of the study suggested that some patients with ITP might have a transient exacerbation of their thrombocytopenia, some with symptoms, within 1 week of their COVID-19 vaccination. It was recommended that ITP patients should still undergo at least the initial vaccination for COVID-19.  This report was serious (Other Medically Important Condition).; Sender's Comments: V0:  This spontaneous report from a literature concerns a 60-year-old male patient of unknown ethnicity, with concurrent immune thrombocytopenia (ITP) and splenectomy, who was noted to have worsening of ITP 5 days after vaccination, with platelet count of 1 to 7x10*9/L.  Signs and symptoms reported was petechiae, ecchymoses, epistaxis, and oral blood blisters. Platelet count prior to vaccination was 270x10*9/L.  There were reported prior relapses every 3-5 years that lasted for months and one "severe" relapse after meningococcal vaccination.  Thirty-three days post vaccination the platelet count was 30x10*9/L.  No other details reported.  The event was confounded by the underlying ITP with history of relapses.  However, considering the temporal association of the decline in platelet count after vaccination, the prior exacerbation after meningococcal vaccination, and recently evolving theories in the literature about COVID infections and vaccinations, the potential vaccine contribution cannot be excluded.