Recurrent Immune Thrombocytopenia After Influenza Vaccination: A Case Report

Hamiel, Uri; Kventsel, Iris; Youngster, Ilan

doi:10.1542/peds.2016-0124

Cited by 31 publications

(25 citation statements)

References 21 publications

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“…The possibility of recurrent ITP associated with vaccines other than MMR is even less wel-described. There is one case report in literature describing recurrent ITP associated with repeated influenza vaccination 18. In our case, the patient had an initial episode of MMR vaccine-associated ITP followed by an episode of ITP after being immunised with vaccines other than MMR, although it is impossible to determine which of the Tdap-IPV, pneumococcal and meningococcal vaccines was the trigger.…”

Section: Discussionmentioning

confidence: 80%

Recurrent immune thrombocytopenia following different vaccines

Morin

Sadarangani²

2019

BMJ Case Rep

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A boy developed immune thrombocytopenia 2 weeks after receiving his measles-mumps-rubella and varicella vaccines at 12 months of age. He then had a recurrent episode 1 week after the booster doses of his quadrivalent diphtheria-tetanus-pertussis-polio, pneumococcal and meningococcal group C vaccines at 5 years of age. On both the occasions he required hospitalisation and treatment with intravenous immunoglobulin. He received other vaccines, before and in between, without any adverse events. Future vaccines are to be determined on an individual risk-benefit basis and he will be reviewed at the age of 11 when his next routine immunisations are due.

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Section: Discussionmentioning

confidence: 80%

Recurrent immune thrombocytopenia following different vaccines

Morin

Sadarangani²

2019

BMJ Case Rep

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“…Prior retrospective studies showed that there is a risk of developing ITP after receiving measles-mumps-rubella, hepatitis A, varicella and diphtheria-tetanus-pertussis vaccines in children and adolescents 3. A number of case-control studies and case reports regarding post-influenza vaccination ITP have been published 4–8. Vaccine-associated ITP may be caused by molecular mimicry, which demands the activation of autoreactive B or T cells by peptides in the vaccine that display structural parallel to antigens found on platelets 3.…”

Section: Discussionmentioning

confidence: 99%

“…The time frame of development of ITP in relation to the epistaxis is notable in this case. At least one case report has had a child develop three occurrences of ITP, each within 1 week of receiving the influenza trivalent vaccine 7. It is possible that with first exposure, there is a prolonged period of time before symptoms and that repeat exposures produce an anamnestic, symptomatic response which is both more brisk and more severe.…”

Section: Discussionmentioning

confidence: 99%

Epistaxis and gross haematuria with severe thrombocytopaenia associated with influenza vaccination

et al. 2019

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Epistaxis may be attributed to many causes during the winter including dry mucous membranes from low indoor humidity from heating. However, epistaxis may also be due to thrombocytopaenia. Immune thrombocytopaenia purpura (ITP) is an autoimmune disorder causing thrombocytopaenia. Viral infections sometimes lead to ITP. Vaccines, predominantly the measles-mumps-rubella vaccine, have been associated with the development of ITP. There are several published case reports regarding influenza vaccine induced ITP. However, an association between ITP and influenza vaccination has not been firmly proven yet. We report the case of an adult with three episodes of epistaxis, each within 1 week of receiving a yearly influenza trivalent inactivated vaccine, the last episode being more severe and also featuring gross haematuria.

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“…Immune thrombocytopenia purpura (ITP) was reported and reviewed as an AEFI following administration of measlesmumps-rubella, hepatitis B, and hepatitis A vaccinations [6,7]. A study by Hamiel et al recounted bleeding symptoms as a manifestation of thrombocytopenia in a patient receiving the influenza vaccine [8]. Susanah et al reported bleeding manifestations as AEFI cases in West Java Province, Indonesia, most due to vitamin K deficiency, followed by cases caused by underlying diseases, either hereditary hemostasis disorders such as hemophilia, or acquired hemostasis disorders such as dengue hemorrhagic fever [9].…”

Section: Introductionmentioning

confidence: 99%

Temporal association between serious bleeding and immunization: vitamin K deficiency as main causative factor

et al. 2020

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Background: Bleeding as an adverse event following immunization (AEFI) that is rarely reported in children, although it can be a parental concern. Bleeding episodes ranging in severity from mild to severe and defined as any external and/or internal bleeding can be caused by acquired or hereditary disorders. This study analyzes whether bleeding episodes in children that were recorded as AEFIs are causally associated with immunization and elaborates their etiology. Methods: A cross-sectional study of 388 AEFI cases in children from West Java Provincial Committee in Indonesia confirmed by case findings from 2000 until 2017.Results: Of the total number of cases studied, 55 (14%) involved children aged 5 days to 12 years who presented with bleeding and were referred to a provincial hospital. Analysis revealed that 32 cases were most likely caused by acquired prothrombin complex deficiency (APCD) and 30 of these APCD cases were strongly suspected to be manifestations of vitamin K deficiency bleeding (VKDB). All VKDB subjects were aged 5 days to 3 months without a history of administration of prophylactic vitamin K. When a World Health Organization classification was used, most bleeding cases in this study became coincidental events with a temporal association with immunization. A causality assessment suggested that these cases were causally unrelated. Conclusion: Most cases of bleeding reported as an AEFI were found to be VKDB, which is considered a coincidental event following immunization with a temporal association, and an unrelated category based on the results of a causality assessment. Vitamin K should be administered to all newborns as a prophylactic and AEFI surveillance should be improved based on the low numbers of AEFI reported in Indonesia.

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Recurrent Immune Thrombocytopenia After Influenza Vaccination: A Case Report

Cited by 31 publications

References 21 publications

Recurrent immune thrombocytopenia following different vaccines

Recurrent immune thrombocytopenia following different vaccines

Epistaxis and gross haematuria with severe thrombocytopaenia associated with influenza vaccination

Temporal association between serious bleeding and immunization: vitamin K deficiency as main causative factor

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