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

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:

• ITP
• vaccine
• relapse
• COVID-19

Ethics Statement

MRC/Hamad Medical Corporation ethical committee has reviewed and permitted the study, MRC No 01-21-982. Informed consent was obtained from the study participants. The study has followed the guidelines outlined in the Declaration of Helsinki.

Acknowledgments

Qatar National Library for scientific support.

Disclosure

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.