Newly diagnosed immune thrombocytopenia in a pregnant patient after coronavirus disease 2019 vaccination

Abstract

Over 26 million cases of coronavirus disease 2019 (COVID-19) have been reported in the United States with over 440 000 deaths. Despite COVID-19 vaccine approval, pregnant women were excluded from clinical trials. We report a case of immune thrombocytopenia in the first trimester, which occurred 13 days after initiating the COVID-19 vaccination series. Thorough evaluation, including hematology consultation, established the diagnosis. High-dose oral corticosteroids were started, and she was discharged home with significant improvement in platelet count on her fourth day of hospitalization with no subsequent complications. We advocate that the benefits of COVID-19 vaccination outweigh the risk of infection in pregnancy and that pregnant women should be included in clinical trials. Closer post-vaccination surveillance may be warranted in the pregnant population pending further data.

COVID-19 vaccination among pregnant people in the United States: a systematic review

“…Eleven of the 32 (34%) studies (Figure 2) discussed COVID-19 vaccination-related side effects in pregnant people, [18][19][20][21][22][23] pregnancy outcomes (gestational hypertension, pre-eclampsia, thromboembolism, placental injuries, miscarriage, and stillbirth), 19,[24][25][26][27][28] and neonatal outcomes (preterm birth, congenital anomalies, small size for gestational age, neonatal ICU admission, and neonatal death). 19,[27][28][29] Included studies that evaluated pregnancy and neonatal outcomes following COVID-19 vaccination did not demonstrate harmful effects with respect to pregnancy, 19,24,25,26,27,28 fetal development, 19,27,28 or neonatal outcomes.…”

“…20 Immune thrombocytopenia (ITP) was reported in a case study. 22 Studies showed that the incidence of side-effects (injection-site pain, injection-site soreness, and fatigue) was higher in the second dose of vaccination compared with the first dose. 18,19,21…”

“…Immune thrombocytopenia (ITP) was reported in one case study. 22 This very rare event has an incidence ranging from 1 case per 26,000 to 1 case per 127,000 doses, 57 and may be resolved by oral corticosteroids without subsequent complications. 22 The protective effects of COVID-19 vaccines in pregnant people were similar to that of the general population.…”

“…22 This very rare event has an incidence ranging from 1 case per 26,000 to 1 case per 127,000 doses, 57 and may be resolved by oral corticosteroids without subsequent complications. 22 The protective effects of COVID-19 vaccines in pregnant people were similar to that of the general population. Pregnant people elicited a robust immune response after vaccination with immunogenicity equivalent to non-pregnant people.…”

Immune thrombocytopenic purpura induced by the COVID‑19 vaccine after the second dose in a 78‑year‑old patient: A case report

“…The pathogenesis of ITP involves autoantibodies produced by B cells, which target PLT membrane glycoproteins, particularly GpIIb/IIIa, and the production of anti-PLT antibodies results in T cell-mediated PLT destruction and impaired megakaryocyte function. The most common predisposing factors for ITP include environmental factors (e.g., infections, drugs and malignancies), genetic predisposition and viral infections (6)(7)(8)(9). At the same time, there is evidence that ITP may develop after various vaccinations (10)(11)(12)(13)(14).…”