SARS-CoV-2 vaccination and ITP in patients with de novo or preexisting ITP
| Autor: | James B. Bussel, David J. Kuter, Alexandra Kruse, Andrew D. Leavitt, Douglas B. Cines, Howard A. Liebman, Jennifer DiRaimo, Terry Gernsheimer, Jecko Thachil, Caroline Kruse, Marina Beltrami Moreira, Adam Cuker, Craig M. Kessler, Michael D. Tarantino, Ashley Ray, Eun-Ju Lee, Hanny Al-Samkari, Adrian C. Newland, Alfred Ian Lee |
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| Rok vydání: | 2021 |
| Předmět: |
Blood Platelets
Male medicine.medical_specialty COVID-19 Vaccines Exacerbation Platelet disorder medicine.medical_treatment Immunology Splenectomy Biochemistry immune system diseases Risk Factors hemic and lymphatic diseases Internal medicine Medicine Humans Platelet Adverse effect Aged Retrospective Studies Aged 80 and over Purpura Thrombocytopenic Idiopathic biology business.industry SARS-CoV-2 COVID-19 Retrospective cohort study Cell Biology Hematology Middle Aged United Kingdom Vaccination biology.protein Female Antibody business |
| Zdroj: | Blood. 139(10) |
| ISSN: | 1528-0020 |
| Popis: | Cases of de novo immune thrombocytopenia (ITP), including a fatality, following SARS-CoV-2 vaccination in previously healthy recipients led to studying its impact in preexisting ITP. In this study, 4 data sources were analyzed: the Vaccine Adverse Events Reporting System (VAERS) for cases of de novo ITP; a 10-center retrospective study of adults with preexisting ITP receiving SARS-CoV-2 vaccination; and surveys distributed by the Platelet Disorder Support Association (PDSA) and the United Kingdom (UK) ITP Support Association. Seventy-seven de novo ITP cases were identified in VAERS, presenting with median platelet count of 3 [1-9] ×109/L approximately 1 week postvaccination. Of 28 patients with available data, 26 responded to treatment with corticosteroids and/or intravenous immunoglobulin (IVIG), and/or platelet transfusions. Among 117 patients with preexisting ITP who received a SARS-CoV-2 vaccine, 19 experienced an ITP exacerbation (any of: ≥50% decline in platelet count, nadir platelet count 20% decrease from baseline, and/or use of rescue therapy) following the first dose and 14 of 70 after a second dose. Splenectomized persons and those who received 5 or more prior lines of therapy were at highest risk of ITP exacerbation. Fifteen patients received and responded to rescue treatment. In surveys of both 57 PDSA and 43 UK patients with ITP, prior splenectomy was associated with worsened thrombocytopenia. ITP may worsen in preexisting ITP or be identified de novo post–SARS-CoV2 vaccination; both situations responded well to treatment. Proactive monitoring of patients with known ITP, especially those postsplenectomy and with more refractory disease, is indicated. |
| Databáze: | OpenAIRE |
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