Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK.
Haemostasis Research Institute, University College London, London, UK.
J Thromb Haemost. 2022 Jun;20(6):1476-1484. doi: 10.1111/jth.15704. Epub 2022 Apr 5.
Immune thrombocytopenic purpura (ITP) relapse following vaccination remains poorly reported in the adult population.
This report details real world data from the largest single-center cohort of ITP relapse following severe acute respiratory syndrome (SARS-CoV-2) vaccination.
The vaccination status of 294 patients under active follow-up was reviewed. A total of 17 patients were identified resulting in an incidence of ITP relapse following SARS-CoV-2 vaccination in this cohort of 6.6% and an incidence of newly diagnosed ITP following SARS-CoV-2 vaccination of 1.4%.
Patients were noted to develop marked deviation of platelet count from baseline following vaccination (P =< .0001). Fourteen patients had a prior diagnosis of ITP and median follow-up following diagnosis was 4 years (range 0-45 years). Days from vaccination to presentation ranged from 2-42 (median 14) and the follow-up period was 34 weeks. Fifteen patients (88%) presented with symptoms and all 17 patients developed symptoms during the follow-up period. Nine patients (53%) received a second dose of vaccine during the follow-up period with seven patients (78%) requiring therapeutic support to facilitate second vaccination. Decision to treat patients was multi-factorial and aimed at decreasing bleeding symptoms and obtaining a platelet count >30 × 10 /L. Sixteen patients (94%) required therapeutic intervention and at the end of the follow-up period, four patients (24%) remained unresponsive to treatment with a platelet count <30 × 10 /L.
Vaccination of ITP patients continues to have important clinical benefit; however, recommendations for patients who relapse remain lacking. This report outlines the real-world patient outcomes in the era of widespread SARS-CoV-2 vaccination.
免疫性血小板减少性紫癜（ITP）在成人人群中接种疫苗后复发的情况报道较少。
本报告详细介绍了 SARS-CoV-2 疫苗接种后 ITP 复发的最大单中心队列的真实世界数据。
对 294 例正在接受主动随访的患者的疫苗接种情况进行了回顾。共发现 17 例患者，导致该队列 SARS-CoV-2 疫苗接种后 ITP 复发的发生率为 6.6%，SARS-CoV-2 疫苗接种后新发 ITP 的发生率为 1.4%。
患者在接种疫苗后血小板计数从基线显著偏离（P<0.0001）。14 例患者有 ITP 既往诊断，诊断后中位随访时间为 4 年（范围 0-45 年）。从接种疫苗到就诊的天数为 2-42 天（中位数为 14 天），随访期为 34 周。15 例患者（88%）出现症状，所有 17 例患者均在随访期间出现症状。9 例患者（53%）在随访期间接受了第二剂疫苗接种，其中 7 例患者（78%）需要治疗支持以促进第二剂疫苗接种。治疗患者的决策是多方面的，旨在减少出血症状并使血小板计数>30×10 /L。16 例患者（94%）需要治疗干预，在随访期末，4 例患者（24%）的血小板计数<30×10 /L，对治疗无反应。
ITP 患者接种疫苗仍然具有重要的临床获益；然而，对于复发患者的建议仍然缺乏。本报告概述了 SARS-CoV-2 疫苗广泛接种时代的真实世界患者结局。
