Immune Thrombocytopenic Purpura After SARS-CoV-2 Moderna® Vaccine: A Case Study

Authors

  • Nina Den Boer Serviço de Medicina 2, Unidade Local de Saúde do Algarve, Faro, Portugal
  • Tiago Martins Branco Serviço de Medicina 2, Unidade Local de Saúde do Algarve, Faro, Portugal
  • Carlos Baptista Serviço de Medicina 2, Unidade Local de Saúde do Algarve, Faro, Portugal
  • Eduarda Alves Serviço de Medicina 2, Unidade Local de Saúde do Algarve, Faro, Portugal
  • Iryna Lazenko Serviço de Medicina 2, Unidade Local de Saúde do Algarve, Faro, Portugal

DOI:

https://doi.org/10.60591/crspmi.146

Keywords:

2019-nCoV Vaccine mRNA-1273, COVID-19 Vaccines/ adverse effects, COVID-19, Purpura, Thrombocytopenic, Idiopathic/chemically induced, SARS-CoV-2

Abstract

condition in which pathogenic antibodies bind to platelets,
accelerating their elimination from the circulation. This case
is about a 65-year-old woman with fatigue, myalgias and localized purpura on the legs, with onset of signs and symptoms 2 days after vaccination. One month earlier, the platelet count was 157x10^9/L. On admission, platelet count was 5x10^9/L, with severe thrombocytopenia confirmed on peripheral blood smear. She was given prednisolone 1 mg/kg/day. After 7 days, the platelet count was 45x10^9/L with resolution of symptoms. Autoimmunity studies, thyroid hormones, coagulation, protein electrophoresis and serological tests were normal. A cause-effect relationship between vaccination and the onset of clinical symptoms was considered probable. INFARMED considered the relationship with the Moderna® vaccine to be probable, as this was the first case in Portugal.

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References

Swinkels M, Rijkers M, Voorberg J, Vidarsson G, Leebeek FW, Jansen AJ. Emerging Concepts in Immune Thrombocytopenia. Front Immunol. 2018;9:880. doi: 10.3389/fimmu.2018.00880

Michel M. Immune thrombocytopenia nomenclature, consensus reports, and guidelines: what are the consequences for daily practice and clinical research? Semin Hematol. 2013;50 Suppl 1:S50-4. doi: 10.1053/j.seminhematol. 2013.03.008.

Cines DB, Bussel JB, Liebman HA, Luning Prak ET. The ITP syndrome: pathogenic and clinical diversity. Blood. 2009;113:6511-21. doi: 10.1182/blood-2009-01-129155

Rinaldi M, Perricone C, Ortega-Hernandez OD, Perricone R, Shoenfeld Y. Immune thrombocytopaenicpurpura: an autoimmune cross–

link between infections and vaccines. Lupus. 2014;23:554–67. doi: 10.1177/0961203313499959

Giordano P, Cascioli S, Lassandro G, Marcellini V, Cardinale F, Valente F, et al. B-cell hyperfunction in children with immune thrombocytopenic purpura persists after splenectomy. Ped Res. 2016;79:262–70. doi:10.1038/pr.2015.211

Yokomichi H, Tanaka-Taya K, Koshida R, Nakano T, Yasui Y, Mori M, et al. Immune thrombocytopenic purpura risk by live, inactivated and simultaneous vaccinations among Japanese adults, children and infants: a matched case-control study. Int J Hematol. 2020;112:105-14. doi:10.1007/s12185-020-02866-1

Jackson LA, Anderson EJ, Rouphael NG, Roberts PC, Makhene M, Coler RN, et al. An mRNA Vaccine against SARS-CoV-2 - Preliminary Report. N Engl J Med. 2020;383:1920-31. doi: 10.1056/NEJMoa2022483.

Helms JM, Ansteatt KT, Roberts JC, Kamatam S, Foong KS, Labayog JS, Tarantino MD. Severe, Refractory Immune Thrombocytopenia Occurring After SARS-CoV-2 Vaccine. J Blood Med. 2021;12:221-4. doi: 10.2147/JBM.S307047.

Lee EJ, Cines DB, Gernsheimer T, Kessler C, Michel M, Tarantino MD, Semple JW, Arnold DM, Godeau B, Lambert MP, Bussel JB. Thrombocytopenia following Pfizer and Moderna SARS-CoV-2 vaccination. Am J Hematol. 2021;96:534-7. doi: 10.1002/ajh.26132.

Malayala SV, Mohan G, Vasireddy D, Atluri P. Purpuric Rash and Thrombocytopenia After the mRNA-1273 (Moderna) COVID-19 Vaccine. Cureus. 2021;13:e14099. doi: 10.7759/cureus.14099.

Welsh KJ, Baumblatt J, Chege W, Goud R, Nair N. Thrombocytopenia including immune thrombocytopenia after receipt of mRNA COVID-19 vaccines reported to the Vaccine Adverse Event Reporting System (VAERS). Vaccine. 2021;39:3329-32. doi: 10.1016/j.vaccine.2021.04.054.

Yocum A, Simon EL. Thrombotic Thrombocytopenic Purpura after Ad26. COV2-S Vaccination. Am J Emerg Med. 2021;49:441.e3-441.e4. doi: 10.1016/j.ajem.2021.05.001.

Saudagar V, Patil S, Goh S, Pothiawala S. Vigilance regarding immune thrombocytopenic purpura after COVID-19 vaccine. Ir J Med Sci. 2021:1–2. doi: 10.1007/s11845-021-02614-2.

Bhattacharjee S, Banerjee M. Immune Thrombocytopenia Secondary to COVID-19: a Systematic Review. SN Compr Clin Med. 2020:1-11. doi: 10.1007/s42399-020-00521-8.

Published

24-06-2024

How to Cite

Den Boer, N., Martins Branco, T., Baptista, C., Alves, E., & Lazenko, I. (2024). Immune Thrombocytopenic Purpura After SARS-CoV-2 Moderna® Vaccine: A Case Study. SPMI Case Reports, 2(Edição Especial), 5–7. https://doi.org/10.60591/crspmi.146