Immune Thrombocytopenia Relapse in Patients Who Received mRNA COVID-19 Vaccines

Abstract

Background Immune thrombocytopenia (ITP) is a blood disorder in which antibodies coating platelets cause platelet destruction in the spleen with a resultant low platelet count and an increased tendency for bleeding. Coronavirus disease 2019 (COVID-19) is an illness caused by SARS-CoV-2. Though pneumonia and respiratory failure are major causes of morbidity and mortality, multisystemic complications were identified, including hematological ones. Several ITP relapse cases post-mRNA SARS-CoV-2 vaccines have been reported, and different pathophysiological theories have been proposed. Purpose The objective of this study is to identify the causal relationship between mRNA COVID-19 vaccines and ITP relapse, to highlight the longer-term effect of these vaccines on the platelet count more than 6 months after receiving the vaccine, and to identify if there is a statistical difference between Comirnaty and Spikevax vaccines on ITP relapse rate. Patients and Methods In this retrospective study, 67 patients with known ITP were followed before and after receiving the mRNA COVID-19 vaccine. The follow-up parameters included platelet counts when available and bleeding symptoms. All patients were adults over 18 years old, with no other identified causes of thrombocytopenia. Forty-seven patients received the Comirnaty vaccine, and 20 patients received the Spikevax vaccine. Results Data analysis showed 6% ITP relapse in the first 3 months, and a 10% relapse rate 3–6 months after receiving one of the mRNA COVID-19 vaccines, with no statically significant difference between the two vaccines. Conclusion mRNA COVID-19 vaccines increase the risk of ITP relapse and can lead to a prolonged reduction in platelet count in a proportion of ITP patients, with no statistically significant difference between Comirnaty and Spikevax vaccines.

COVID-19 and SLE: Infection and autoimmunity at its best

“…70 The mRNA COVID-19 vaccines were also thought to trigger immune thrombocytopenia flares as a significant number of patients, known to have immune thrombocytopenia, had relapses within a year of receiving the second doses of either the BNT162b2 or the mRNA-1273 vaccines. 71 Furthermore, in a review of several studies, 66 patients were found to have immune thrombocytopenia after the administration of COVID-19 vaccination. 72 The mRNA vaccines were found to have triggered immune thrombocytopenia episodes more than other types of COVID-19 vaccines.…”

Immune Thrombocytopenia Relapse in Patients Who Received mRNA COVID-19 Vaccines [Letter]

“…We have read the research conducted by Hana Qasim et al 1 with great interest. We appreciate the author for sharing her experience and would like to share our outlook which has raised a few questions in our mind.…”