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

Hana Qasim,1,2 Alaa Rahhal,3 Ahmed Husain,4 Abdelkarim Alammora,5 Khaled Alsa’ed,5 Ahmed Abdelghafar Masaad Alsayed,5 Baha Faiyoumi,5 Leen Maen AbuAfifeh,5 Mohammad Abu-Tineh,1 Awni Alshurafa,1 Mohamed A Yassin1 1Hematology-Oncology Department, National Centre for Cancer Care & Research, Doha, Qatar; 2Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO, USA; 3MSc Pharmacy Department, Hamad Medical Corporation, Doha, Qatar; 4Infectious Disease Department, Communicable Disease Center, Hamad Medical Corporation, Doha, Qatar; 5Internal Medicine Department, Hamad Medical Corporation, Doha, QatarCorrespondence: Hana Qasim; Khaled Alsa’ed, Email Hanaa.qasem1@gmail.com; KAlsaed@hamad.qaBackground: 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