Treatment, outcome and re-vaccination of patients with SARS-CoV-2 vaccine-associated immune thrombocytopenia
Purpose Following the emergency use authorization of BNT162b2 by the Food and Drug administration (FDA) in early December 2020, mRNA- and vector-based vaccines became an important means of reducing the spread and mortality of the COVID-19 pandemic. The European Medicines Agency labelled immune thrombocytopenia (ITP) as a rare adverse reaction of unknown frequency after vector-, but not mRNA-vaccination. Here, we report on the long-term outcome of 6 patients who were diagnosed with de-novo, vaccine-associated ITP (VA-ITP), and on the outcome of subsequent SARS-CoV-2 re-vaccinations. Methods Patients were included after presenting to our emergency department. Therapy was applied according to ITP guidelines. Follow-up data were obtained from outpatient departments. Both mRNA- or vector-based vaccines were each used in 3 cases, respectively. Results In all patients, the onset of symptoms occurred after the 1st dose of vaccine was applied. 5 patients required treatment, 3 of them 2nd line therapy. All patients showed a complete response eventually. After up to 359 days of follow-up, 2 patients were still under 2nd line therapy with thrombopoietin receptor agonists. 5 patients have been re-vaccinated with up to 3 consecutive doses of SARS-CoV-2 vaccines, 4 of them showing stable platelet counts hereafter. Conclusion Thrombocytopenia after COVID-19 vaccination should trigger a diagnostic workup to exclude vaccine-induced immune thrombotic thrombocytopenia (VITT) and, if confirmed, VA-ITP should be treated according to current ITP guidelines. Re-vaccination of patients seems feasible under close monitoring of blood counts and using a vaccine that differs from the one triggering the initial episode of VA-ITP..
Medienart: |
E-Artikel |
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Erscheinungsjahr: |
2022 |
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Erschienen: |
2022 |
Enthalten in: |
Zur Gesamtaufnahme - volume:51 |
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Enthalten in: |
Infection - 51(2022), 1 vom: 04. Okt., Seite 231-238 |
Sprache: |
Englisch |
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Beteiligte Personen: |
Ruzicka, Michael [VerfasserIn] |
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Links: |
Volltext [kostenfrei] |
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Themen: |
COVID-19 |
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Anmerkungen: |
© The Author(s) 2022 |
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doi: |
10.1007/s15010-022-01909-5 |
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funding: |
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Förderinstitution / Projekttitel: |
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PPN (Katalog-ID): |
OLC2133591567 |
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520 | |a Purpose Following the emergency use authorization of BNT162b2 by the Food and Drug administration (FDA) in early December 2020, mRNA- and vector-based vaccines became an important means of reducing the spread and mortality of the COVID-19 pandemic. The European Medicines Agency labelled immune thrombocytopenia (ITP) as a rare adverse reaction of unknown frequency after vector-, but not mRNA-vaccination. Here, we report on the long-term outcome of 6 patients who were diagnosed with de-novo, vaccine-associated ITP (VA-ITP), and on the outcome of subsequent SARS-CoV-2 re-vaccinations. Methods Patients were included after presenting to our emergency department. Therapy was applied according to ITP guidelines. Follow-up data were obtained from outpatient departments. Both mRNA- or vector-based vaccines were each used in 3 cases, respectively. Results In all patients, the onset of symptoms occurred after the 1st dose of vaccine was applied. 5 patients required treatment, 3 of them 2nd line therapy. All patients showed a complete response eventually. After up to 359 days of follow-up, 2 patients were still under 2nd line therapy with thrombopoietin receptor agonists. 5 patients have been re-vaccinated with up to 3 consecutive doses of SARS-CoV-2 vaccines, 4 of them showing stable platelet counts hereafter. Conclusion Thrombocytopenia after COVID-19 vaccination should trigger a diagnostic workup to exclude vaccine-induced immune thrombotic thrombocytopenia (VITT) and, if confirmed, VA-ITP should be treated according to current ITP guidelines. Re-vaccination of patients seems feasible under close monitoring of blood counts and using a vaccine that differs from the one triggering the initial episode of VA-ITP. | ||
650 | 4 | |a Immune thrombocytopenia | |
650 | 4 | |a SARS-CoV-2 | |
650 | 4 | |a Vaccine-associated ITP | |
650 | 4 | |a Post-vaccinal ITP | |
650 | 4 | |a COVID-19 vaccine | |
650 | 4 | |a COVID-19 | |
700 | 1 | |a Wurm, Sonja |0 (orcid)0000-0002-7540-737X |4 aut | |
700 | 1 | |a Lindner, Lars |0 (orcid)0000-0003-3708-8264 |4 aut | |
700 | 1 | |a Dreyling, Martin |0 (orcid)0000-0002-0358-5249 |4 aut | |
700 | 1 | |a von Bergwelt-Baildon, Michael |0 (orcid)0000-0002-1952-052X |4 aut | |
700 | 1 | |a Boeck, Stefan |0 (orcid)0000-0002-1922-2127 |4 aut | |
700 | 1 | |a Giessen-Jung, Clemens |4 aut | |
700 | 1 | |a Milani, Valeria |4 aut | |
700 | 1 | |a Stemmler, Joachim H. |0 (orcid)0000-0001-8751-8555 |4 aut | |
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700 | 1 | |a Spiekermann, Karsten |0 (orcid)0000-0002-5139-4957 |4 aut | |
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