Immune thrombocytopenia and COVID-19 vaccination: Outcomes and comparisons to prepandemic patients

Philip Young Ill Choi; Danny Hsu; Huyen Anh Tran; Chee Wee Tan; Anoop Enjeti; Vivien Mun Yee Chen; Eileen Merriman; Agnes S.M. Yong; Jock Simpson; Elizabeth Gardiner; Nicolas Cherbuin; Jennifer Curnow; Dominic Pepperell; Robert Bird

doi:10.1016/j.rpth.2022.100009

Immune thrombocytopenia and COVID-19 vaccination: Outcomes and comparisons to prepandemic patients

Philip Young Ill Choi^*, Danny Hsu, Huyen Anh Tran, Chee Wee Tan, Anoop Enjeti, Vivien Mun Yee Chen, Eileen Merriman, Agnes S.M. Yong, Jock Simpson, Elizabeth Gardiner, Nicolas Cherbuin, Jennifer Curnow, Dominic Pepperell, Robert Bird

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

4 Citations (Scopus)

Abstract

Background: Immune thrombocytopenia (ITP) has been reported following COVID-19 vaccination. After index case fatalities, there was concern among patients both with and without a prior history of ITP in Australia.

Objectives: To describe treatment outcomes of ITP after COVID-19 vaccination and compare relapsed vs historical pre-COVID-19 ITP cohorts.

Methods: We collected ITP cases in Australia within 6 weeks of receiving any COVID-19 vaccination as part of primary vaccination (up to October 17, 2021). Second, we reviewed platelet charts in a historical ITP cohort to determine whether platelet variability was distinct from relapsed ITP after vaccination.

Results: We report on 50 patients (37 de novo, 13 relapsed ITP) vaccinated from March 22, 2021, to October 17, 2021. Although there was 1 fatality, bleeding was otherwise mostly minor: (70% WHO bleeding grade <2). De novo ITP was more likely after AstraZeneca ChAdOx1 nCoV-19 (89%) than Pfizer BNT162b2 (11%). Most patients responded quickly (median, 4 days; complete response, 40 of 45 [89%]). In the historical cohort, only 6 of 47 patients exhibited platelet variability (>50% decrease and platelets <100 × 10⁹/L), but median platelet nadir was significantly higher than vaccination relapse (27 vs 6 × 10⁹/L, P =.005).

Conclusion: ITP was more frequently reported after AstraZeneca ChAdOx1 nCoV-19 than Pfizer BNT162b2 vaccination. Standard ITP treatments remain highly effective for de novo and relapsed ITP (96%). Although thrombocytopenia can be severe after vaccination, bleeding is usually mild. Despite some sampling bias, our data do not support a change in treatment strategies for patients with ITP after vaccination.

Original language	English
Article number	100009
Number of pages	13
Journal	Research and Practice in Thrombosis and Haemostasis
Volume	7
Issue number	1
Early online date	13 Dec 2022
DOIs	https://doi.org/10.1016/j.rpth.2022.100009
Publication status	Published - Jan 2023

Access to Document

10.1016/j.rpth.2022.100009

Cite this

Choi, P. Y. I., Hsu, D., Tran, H. A., Tan, C. W., Enjeti, A., Chen, V. M. Y., Merriman, E., Yong, A. S. M., Simpson, J., Gardiner, E., Cherbuin, N., Curnow, J., Pepperell, D., & Bird, R. (2023). Immune thrombocytopenia and COVID-19 vaccination: Outcomes and comparisons to prepandemic patients. Research and Practice in Thrombosis and Haemostasis, 7(1), Article 100009. https://doi.org/10.1016/j.rpth.2022.100009

@article{ad01f3b929df40e18665c8c87630e294,

title = "Immune thrombocytopenia and COVID-19 vaccination: Outcomes and comparisons to prepandemic patients",

abstract = "Background: Immune thrombocytopenia (ITP) has been reported following COVID-19 vaccination. After index case fatalities, there was concern among patients both with and without a prior history of ITP in Australia. Objectives: To describe treatment outcomes of ITP after COVID-19 vaccination and compare relapsed vs historical pre-COVID-19 ITP cohorts. Methods: We collected ITP cases in Australia within 6 weeks of receiving any COVID-19 vaccination as part of primary vaccination (up to October 17, 2021). Second, we reviewed platelet charts in a historical ITP cohort to determine whether platelet variability was distinct from relapsed ITP after vaccination. Results: We report on 50 patients (37 de novo, 13 relapsed ITP) vaccinated from March 22, 2021, to October 17, 2021. Although there was 1 fatality, bleeding was otherwise mostly minor: (70% WHO bleeding grade <2). De novo ITP was more likely after AstraZeneca ChAdOx1 nCoV-19 (89%) than Pfizer BNT162b2 (11%). Most patients responded quickly (median, 4 days; complete response, 40 of 45 [89%]). In the historical cohort, only 6 of 47 patients exhibited platelet variability (>50% decrease and platelets <100 × 109/L), but median platelet nadir was significantly higher than vaccination relapse (27 vs 6 × 109/L, P =.005). Conclusion: ITP was more frequently reported after AstraZeneca ChAdOx1 nCoV-19 than Pfizer BNT162b2 vaccination. Standard ITP treatments remain highly effective for de novo and relapsed ITP (96%). Although thrombocytopenia can be severe after vaccination, bleeding is usually mild. Despite some sampling bias, our data do not support a change in treatment strategies for patients with ITP after vaccination.",

keywords = "BNT162 vaccine, COVID-19 vaccines, ChAdOx1 nCov-19, immune thrombocytopenia, treatment outcome, vaccination",

author = "Choi, {Philip Young Ill} and Danny Hsu and Tran, {Huyen Anh} and Tan, {Chee Wee} and Anoop Enjeti and Chen, {Vivien Mun Yee} and Eileen Merriman and Yong, {Agnes S.M.} and Jock Simpson and Elizabeth Gardiner and Nicolas Cherbuin and Jennifer Curnow and Dominic Pepperell and Robert Bird",

note = "Publisher Copyright: {\textcopyright} 2022 The Authors",

year = "2023",

month = jan,

doi = "10.1016/j.rpth.2022.100009",

language = "English",

volume = "7",

journal = "Research and Practice in Thrombosis and Haemostasis",

issn = "2475-0379",

publisher = "Elsevier B.V.",

number = "1",

}

Choi, PYI, Hsu, D, Tran, HA, Tan, CW, Enjeti, A, Chen, VMY, Merriman, E, Yong, ASM, Simpson, J, Gardiner, E , Cherbuin, N, Curnow, J, Pepperell, D & Bird, R 2023, 'Immune thrombocytopenia and COVID-19 vaccination: Outcomes and comparisons to prepandemic patients', Research and Practice in Thrombosis and Haemostasis, vol. 7, no. 1, 100009. https://doi.org/10.1016/j.rpth.2022.100009

TY - JOUR

T1 - Immune thrombocytopenia and COVID-19 vaccination

T2 - Outcomes and comparisons to prepandemic patients

AU - Choi, Philip Young Ill

AU - Hsu, Danny

AU - Tran, Huyen Anh

AU - Tan, Chee Wee

AU - Enjeti, Anoop

AU - Chen, Vivien Mun Yee

AU - Merriman, Eileen

AU - Yong, Agnes S.M.

AU - Simpson, Jock

AU - Gardiner, Elizabeth

AU - Cherbuin, Nicolas

AU - Curnow, Jennifer

AU - Pepperell, Dominic

AU - Bird, Robert

PY - 2023/1

Y1 - 2023/1

N2 - Background: Immune thrombocytopenia (ITP) has been reported following COVID-19 vaccination. After index case fatalities, there was concern among patients both with and without a prior history of ITP in Australia. Objectives: To describe treatment outcomes of ITP after COVID-19 vaccination and compare relapsed vs historical pre-COVID-19 ITP cohorts. Methods: We collected ITP cases in Australia within 6 weeks of receiving any COVID-19 vaccination as part of primary vaccination (up to October 17, 2021). Second, we reviewed platelet charts in a historical ITP cohort to determine whether platelet variability was distinct from relapsed ITP after vaccination. Results: We report on 50 patients (37 de novo, 13 relapsed ITP) vaccinated from March 22, 2021, to October 17, 2021. Although there was 1 fatality, bleeding was otherwise mostly minor: (70% WHO bleeding grade <2). De novo ITP was more likely after AstraZeneca ChAdOx1 nCoV-19 (89%) than Pfizer BNT162b2 (11%). Most patients responded quickly (median, 4 days; complete response, 40 of 45 [89%]). In the historical cohort, only 6 of 47 patients exhibited platelet variability (>50% decrease and platelets <100 × 109/L), but median platelet nadir was significantly higher than vaccination relapse (27 vs 6 × 109/L, P =.005). Conclusion: ITP was more frequently reported after AstraZeneca ChAdOx1 nCoV-19 than Pfizer BNT162b2 vaccination. Standard ITP treatments remain highly effective for de novo and relapsed ITP (96%). Although thrombocytopenia can be severe after vaccination, bleeding is usually mild. Despite some sampling bias, our data do not support a change in treatment strategies for patients with ITP after vaccination.

AB - Background: Immune thrombocytopenia (ITP) has been reported following COVID-19 vaccination. After index case fatalities, there was concern among patients both with and without a prior history of ITP in Australia. Objectives: To describe treatment outcomes of ITP after COVID-19 vaccination and compare relapsed vs historical pre-COVID-19 ITP cohorts. Methods: We collected ITP cases in Australia within 6 weeks of receiving any COVID-19 vaccination as part of primary vaccination (up to October 17, 2021). Second, we reviewed platelet charts in a historical ITP cohort to determine whether platelet variability was distinct from relapsed ITP after vaccination. Results: We report on 50 patients (37 de novo, 13 relapsed ITP) vaccinated from March 22, 2021, to October 17, 2021. Although there was 1 fatality, bleeding was otherwise mostly minor: (70% WHO bleeding grade <2). De novo ITP was more likely after AstraZeneca ChAdOx1 nCoV-19 (89%) than Pfizer BNT162b2 (11%). Most patients responded quickly (median, 4 days; complete response, 40 of 45 [89%]). In the historical cohort, only 6 of 47 patients exhibited platelet variability (>50% decrease and platelets <100 × 109/L), but median platelet nadir was significantly higher than vaccination relapse (27 vs 6 × 109/L, P =.005). Conclusion: ITP was more frequently reported after AstraZeneca ChAdOx1 nCoV-19 than Pfizer BNT162b2 vaccination. Standard ITP treatments remain highly effective for de novo and relapsed ITP (96%). Although thrombocytopenia can be severe after vaccination, bleeding is usually mild. Despite some sampling bias, our data do not support a change in treatment strategies for patients with ITP after vaccination.

KW - BNT162 vaccine

KW - COVID-19 vaccines

KW - ChAdOx1 nCov-19

KW - immune thrombocytopenia

KW - treatment outcome

KW - vaccination

UR - http://www.scopus.com/inward/record.url?scp=85149846234&partnerID=8YFLogxK

U2 - 10.1016/j.rpth.2022.100009

DO - 10.1016/j.rpth.2022.100009

M3 - Article

SN - 2475-0379

VL - 7

JO - Research and Practice in Thrombosis and Haemostasis

JF - Research and Practice in Thrombosis and Haemostasis

IS - 1

M1 - 100009

ER -

Immune thrombocytopenia and COVID-19 vaccination: Outcomes and comparisons to prepandemic patients

Abstract

Access to Document

Other files and links

Fingerprint

Cite this