Immune Thrombocytopenia Relapse in Patients Who Received mRNA COVID-19 Vaccines

Hana Qasim; Alaa Rahhal; Ahmed Husain; Abdelkarim Alammora; Khaled Alsa'ed; Ahmed Abdelghafar Masaad Alsayed; Baha Faiyoumi; Leen Maen AbuAfifeh; Mohammad Abu-Tineh; Awni Alshurafa; Mohamed A Yassin

doi:10.2147/JBM.S396026

Immune Thrombocytopenia Relapse in Patients Who Received mRNA COVID-19 Vaccines

J Blood Med. 2023 Apr 14:14:295-302. doi: 10.2147/JBM.S396026. eCollection 2023.

Authors

Affiliations

¹ Hematology-Oncology Department, National Centre for Cancer Care & Research, Doha, Qatar.
² Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO, USA.
³ MSc Pharmacy Department, Hamad Medical Corporation, Doha, Qatar.
⁴ Infectious Disease Department, Communicable Disease Center, Hamad Medical Corporation, Doha, Qatar.
⁵ Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar.

Abstract

Background: Immune thrombocytopenia (ITP) is a blood disorder in which antibodies coating platelets cause platelet destruction in the spleen with a resultant low platelet count and an increased tendency for bleeding. Coronavirus disease 2019 (COVID-19) is an illness caused by SARS-CoV-2. Though pneumonia and respiratory failure are major causes of morbidity and mortality, multisystemic complications were identified, including hematological ones. Several ITP relapse cases post-mRNA SARS-CoV-2 vaccines have been reported, and different pathophysiological theories have been proposed.

Purpose: The objective of this study is to identify the causal relationship between mRNA COVID-19 vaccines and ITP relapse, to highlight the longer-term effect of these vaccines on the platelet count more than 6 months after receiving the vaccine, and to identify if there is a statistical difference between Comirnaty and Spikevax vaccines on ITP relapse rate.

Patients and methods: In this retrospective study, 67 patients with known ITP were followed before and after receiving the mRNA COVID-19 vaccine. The follow-up parameters included platelet counts when available and bleeding symptoms. All patients were adults over 18 years old, with no other identified causes of thrombocytopenia. Forty-seven patients received the Comirnaty vaccine, and 20 patients received the Spikevax vaccine.

Results: Data analysis showed 6% ITP relapse in the first 3 months, and a 10% relapse rate 3-6 months after receiving one of the mRNA COVID-19 vaccines, with no statically significant difference between the two vaccines.

Conclusion: mRNA COVID-19 vaccines increase the risk of ITP relapse and can lead to a prolonged reduction in platelet count in a proportion of ITP patients, with no statistically significant difference between Comirnaty and Spikevax vaccines.

Keywords: COVID-19; ITP; relapse; vaccine.