Recurrent immune thrombocytopenia following different vaccines

Morin, Estelle M.; Sadarangani, Manish

doi:10.1136/bcr-2019-231260

Cited by 6 publications

(4 citation statements)

References 17 publications

(24 reference statements)

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“…After two years of follow-up, none of the children in the vaccine-associated thrombocytopenia subgroup experienced an ITP relapse following re-immunization, while three children with persistent or chronic ITP in the vaccine-unassociated thrombocytopenia subgroup experienced an ITP relapse. Although a few case reports documented recurrent ITP following the same or different vaccinations [ 31 , 32 ], our findings demonstrated that revaccination for children with prior ITP and the administration of the incident vaccine and other vaccines to children with previous vaccine-associated thrombocytopenia did not result in the recurrence or progression of thrombocytopenia. Moreover, the prognosis was usually favorable for children who suffered an episode of vaccine-associated thrombocytopenia.…”

Section: Discussioncontrasting

confidence: 60%

Safety of Immunization for Children with Immune Thrombocytopenia

Wang,

Feng,

Wang

et al. 2024

Vaccines

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Vaccine hesitancy is a common issue for children with immune thrombocytopenia (ITP) in China. The objective of this paper is to assess the immunization statuses of children with ITP, analyze the possible relationship between immunization and thrombocytopenia, and evaluate the safety of immunization after ITP remission. We included 186 children with an ITP history and followed up with them for two years after receiving re-immunization recommendations. The participants had an overall age-appropriate vaccine coverage of 57.9%. Vaccine-associated thrombocytopenia occurred in 99 (53.2%, 95% CI = 46.06–60.26) children ranging from 0 to 34 days following immunization, with 14 vaccines involved. One hundred and fifty-four (82.3%, 95% CI = 76.72–87.54) children were advised to restart immunization, whereas 32 (17.2%, 95% CI = 12.46–23.28) were advised to postpone partial or full vaccination. Following the follow-up, 150 (80.6%, 95% CI = 74.37–85.68) children completed the catch-up immunization, whereas 27 (14.5%, 95% CI = 10.17–20.30) partially completed it. Four patients with thrombocytopenia relapsed following the re-immunization. Incomplete catch-up immunization was related to the factors of chronic thrombocytopenia, vaccine-associated thrombocytopenia, and the relapse of ITP following re-immunization. ITP may occur after immunization with vaccines other than measles-containing vaccines. Re-immunization in children with ITP generally does not result in a relapse, regardless of whether the previous thrombocytopenia was vaccine-associated.

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Section: Discussioncontrasting

confidence: 60%

Safety of Immunization for Children with Immune Thrombocytopenia

Wang,

Feng,

Wang

et al. 2024

Vaccines

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“…The concept of immunization-induced thrombocytopenia is not new, nor is unusual at young age. Namely, ITP, either de novo or a relapse of ITP has been reported to be associated with various vaccines, including measles-mumps-rubella (MMR), Haemophilus influenzae, diphtheria-tetanus-pertussis (DTP), polio and hepatitis B virus, with similar pathogenesis as in COVID-19 mRNA vaccine [23][24][25][26][27]. It is presumed that de novo ITP might be associated with molecular mimicry and circulating immune complexes, and that an ITP relapse is the result of preformed antibodies [28].…”

Section: Discussionmentioning

confidence: 99%

Relapse of Evans syndrome following BNT162b2 (Pfizer-BioNTech) COVID-19 vaccine: case report and literature review

Cvetković¹,

Pantić²,

Virijevic³

et al. 2023

J Infect Dev Ctries

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Introduction: Coronavirus disease 2019 (COVID-19) vaccines are considered to be safe. Only few cases of vaccine-induced immune thrombocytopenia or immune hemolysis have been reported so far. Evans syndrome (ES) is a very rare syndrome characterized mainly by warm autoimmune hemolytic anemia (wAIHA) and immune thrombocytopenia (ITP). Case presentation: We present a case of a 47‐year‐old male with a history of wAIHA, diagnosed in 1995 and successfully treated with glucocorticoids, with sustained remission. ITP was diagnosed in May 2016. Due to refractoriness to glucocorticoids, intravenous immunoglobulins (IVIGs), azathioprine and vinblastine, he was splenectomised in April 2017, resulting in complete remission. In May 2021, eight days after the second dose of BNT162b2 (Pfizer-BioNTech) COVID-19 vaccine, he experienced mucocutaneous bleeding. Blood tests showed platelet count (PC) of 8×109/L, while his hemoglobin (Hb) was normal (153 g/L). He was treated with prednisone and azathioprine, without response. On day 28 after vaccine administration, weakness, jaundice and dark brown urine occurred. His laboratory tests: PC 27×109/L, Hb 45 g/L, reticulocytes 10.4%, total bilirubin 106.6 μmol/L, direct bilirubin 19.8 μmol/L, lactate dehydrogenase 633 U/L, haptoglobin ˂0.08 g/L, and positive Coombs test were consistent with ES relapse. After treatment with glucocorticoids, azathioprine and IVIGs, his blood count finally improved (PC 490×109/L, Hb 109 g/L) and remained stable on day 40 of hospitalization. Conclusions: Although it is unclear whether the relationship between COVID-19 vaccination and relapse of ES in our patient is coincidental or causal, it highlights the need for monitoring of serious outcomes following vaccination.

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“…Delayed reactions include [4]: cytotoxic reactions (type II), i.e. thrombocytopenia after administration of the measles-rubella vaccine [15][16][17]; reactions mediated by immune complexes (type III), i.e. serum sickness [18][19][20], Arthus reaction [21-22], erythema nodosum [23][24] or Henoch-…”

Section: Classification Of the Adverse Reactions To Vaccinesmentioning

confidence: 99%

“…Injection site reactions include two major patterns: a) pain, redness, and/or swelling and b) persistent subcutaneous itchy nodules at the injection site [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. Their frequency depends on the composition of the vaccine, the number of injections previously administered, and the immunological and inflammatory responses of the host [30,31].…”

Section: Injection Site Reactions To Vaccinesmentioning

confidence: 99%

Diagnosis and management of hypersensitivity reactions to vaccines

Sarti

Lezmi

Mori

et al. 2020

Expert Review of Clinical Immunology

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Information Classification: General Introduction: Many countries in Europe now recommend and enforce mandatory vaccinations to improve vaccination coverage. Thus, the number of adverse events following immunization (AEFI) may show an increase. Among these events, severe hypersensitivity reactions to vaccines are rare. However, it is important that they be identified and recognized so that they may be adequately managed. Areas covered:The literature search was undertaken through PubMed and Embase to identify English-language papers focusing on hypersensitivity to vaccines.Expert opinion: Hypersensitivity reactions following vaccinations are rare and are classified according to their chronology and extension: immediate when they occur within the first 4 hours following administration and non-immediate when they occur later. Local reactions are the most common adverse event following injection of vaccines and generally do not require any allergy workup. Immediate reactions, however, are potentially IgE-mediated and require an allergy workup.In general, a previously known food allergy (i.e. egg or milk) is not a contraindication to immunizations. Patients with a known allergy to gelatin, yeast, latex, antibiotics or other specific components of vaccines require an allergy workup before administration of the vaccine.

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Recurrent immune thrombocytopenia following different vaccines

Cited by 6 publications

References 17 publications

Safety of Immunization for Children with Immune Thrombocytopenia

Safety of Immunization for Children with Immune Thrombocytopenia

Relapse of Evans syndrome following BNT162b2 (Pfizer-BioNTech) COVID-19 vaccine: case report and literature review

Diagnosis and management of hypersensitivity reactions to vaccines

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