Immunization Enigma: Immune Thrombocytopenia Post Vaccination
Location
D.P. Culp Center Ballroom
Start Date
4-5-2024 9:00 AM
End Date
4-5-2024 11:30 AM
Poster Number
97
Name of Project's Faculty Sponsor
Nevi Patel
Faculty Sponsor's Department
Internal Medicine
Competition Type
Competitive
Type
Poster Presentation
Presentation Category
Health
Abstract or Artist's Statement
Immunization Enigma: Immune Thrombocytopenia Post Vaccination Samra Hassan MD, Jeff Thompson DO, Mohammad H Qureshi, MD, Nevi Patel MD Department of Internal Medicine, East Tennessee State University A 45-year-old male with no significant pathological antecedents was referred to the hospital for admission after presenting to the outpatient clinic with petechia. Subsequently, he was found to have significant thrombocytopenia with a platelet count of 7000. Approximately 1 month prior to the presentation the patient traveled to New York for a conference and received COVID and influenza vaccinations at that time. Two weeks following vaccination the patient noted petechiae limited to his bilateral lower extremity. These petechiae progressed, coalescing to form larger ecchymoses, which were prominent over bilateral forearms, knees, and thighs. There was no mucosal bleeding, hemoptysis, hematuria, hematochezia, or melena. Initial work-up included a repeat platelet count of 11,000. The peripheral smear revealed severe thrombocytopenia without schistocytes, blasts, or evidence of hematologic malignancy. HIV, Hepatitis B, and C testing resulted negative. Urine drug screen was unremarkable. Other labs including folate, B12, fibrinogen, LDH, and TSH were within normal limits. Abdominal ultrasound revealed normal hepatic parenchymal architecture without ductal dilatation, splenomegaly, or focal splenic abnormality. Hematology was consulted for isolated thrombocytopenia with spontaneous petechiae. Etiology was suspected to be secondary to ITP. The patient was transfused one unit of platelets and then initiated on prednisone at 1 mg/kg dosing. His platelet count improved to 27,000 on repeat labs the following day. Given the persistence of significant thrombocytopenia, the decision was made to initiate intravenous immunoglobulin (IVIG) therapy. Thrombocytopenia improved to 145,000 after 48 hours of IVIG therapy. He was discharged on a 10-day prednisone taper. Follow-up in the hematology clinic upon completion of steroid taper showed normalization of thrombocytopenia. The repeat platelet count was 258,000. In the setting of his otherwise unremarkable work-up, the presumed etiology of the patient’s ITP was immunization-induced.
Immunization Enigma: Immune Thrombocytopenia Post Vaccination
D.P. Culp Center Ballroom
Immunization Enigma: Immune Thrombocytopenia Post Vaccination Samra Hassan MD, Jeff Thompson DO, Mohammad H Qureshi, MD, Nevi Patel MD Department of Internal Medicine, East Tennessee State University A 45-year-old male with no significant pathological antecedents was referred to the hospital for admission after presenting to the outpatient clinic with petechia. Subsequently, he was found to have significant thrombocytopenia with a platelet count of 7000. Approximately 1 month prior to the presentation the patient traveled to New York for a conference and received COVID and influenza vaccinations at that time. Two weeks following vaccination the patient noted petechiae limited to his bilateral lower extremity. These petechiae progressed, coalescing to form larger ecchymoses, which were prominent over bilateral forearms, knees, and thighs. There was no mucosal bleeding, hemoptysis, hematuria, hematochezia, or melena. Initial work-up included a repeat platelet count of 11,000. The peripheral smear revealed severe thrombocytopenia without schistocytes, blasts, or evidence of hematologic malignancy. HIV, Hepatitis B, and C testing resulted negative. Urine drug screen was unremarkable. Other labs including folate, B12, fibrinogen, LDH, and TSH were within normal limits. Abdominal ultrasound revealed normal hepatic parenchymal architecture without ductal dilatation, splenomegaly, or focal splenic abnormality. Hematology was consulted for isolated thrombocytopenia with spontaneous petechiae. Etiology was suspected to be secondary to ITP. The patient was transfused one unit of platelets and then initiated on prednisone at 1 mg/kg dosing. His platelet count improved to 27,000 on repeat labs the following day. Given the persistence of significant thrombocytopenia, the decision was made to initiate intravenous immunoglobulin (IVIG) therapy. Thrombocytopenia improved to 145,000 after 48 hours of IVIG therapy. He was discharged on a 10-day prednisone taper. Follow-up in the hematology clinic upon completion of steroid taper showed normalization of thrombocytopenia. The repeat platelet count was 258,000. In the setting of his otherwise unremarkable work-up, the presumed etiology of the patient’s ITP was immunization-induced.