Vaccination-Associated relapse of immune thrombocytopenia.

Many patients with immune thrombocytopenia require splenectomy to achieve remission. They are therefore at risk for postsplenectomy septicemia and should receive vaccination against Streptococcus pneumoniae. In experiment situations, antigens contained within this vaccine cell initiate a polyclonal B-lymphocyte activation and increased production of specific and nonspecific antibodies. In certain animal models, a polyclonal B-lymphocyte stimulatory response can trigger an autoimmune disorder. Two patients with immune thrombocytopenia had relapses of their immune thrombocytopenia after the administration of pneumococcal and influenza vaccines. These observations suggest that patients with a history of immune thrombocytopenia should be monitored after vaccination.