Immunization Enigma: Immune Thrombocytopenia Post Vaccination

Authors' Affiliations

Samra Hassan, MD, Department of Internal Medicine, East Tennessee State University, Johnson City, TN. Jefferson Thompson, DO, Department of Internal Medicine, East Tennessee State University, Johnson City, TN.

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

Classification of First Author

Medical Resident or Clinical Fellow

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.

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Apr 5th, 9:00 AM Apr 5th, 11:30 AM

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.