{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T14:33:42Z","timestamp":1775313222584,"version":"3.50.1"},"reference-count":13,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,7,15]],"date-time":"2021-07-15T00:00:00Z","timestamp":1626307200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,7,15]],"date-time":"2021-07-15T00:00:00Z","timestamp":1626307200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Exp Hematol Oncol"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 has emerged as a deadliest global pandemic after its identification in December 2019 in Wuhan, China resulting in more than three million deaths worldwide. Recently FDA issued emergency authorization for three vaccines for prevention of COVID-19. Here in, we report three cases of severe immune thrombocytopenia (ITP) following COVID-19 vaccination and their clinical course.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentations<\/jats:title>\n                <jats:p>Case #1: 53\u00a0year old male with past medical history of Crohn\u2019s disease was admitted for myalgias and diffuse petechial rash 8\u00a0days after receiving second dose of Pfizer-BioNTech COVID-19 vaccine. A complete blood test showed a platelet count of 2\u2009\u00d7\u200910<jats:sup>9<\/jats:sup>\/L. Patient did not have a prior history of thrombocytopenia and other causes of thrombocytopenia were ruled out by history and pertinent lab data. He received two doses of intravenous immunoglobulin and oral dexamethasone for 4\u00a0days resulting in normalization of platelet counts.<\/jats:p>\n                <jats:p>Case #2: 67\u00a0year male with past medical history of chronic ITP in remission was admitted for melena 2\u00a0days after receiving his first dose of Pfizer-BioNTech COVID-19 vaccine. A complete blood test showed a platelet count of 2\u2009\u00d7\u200910<jats:sup>9<\/jats:sup>\/L. Physical exam showed generalized petechiae. There was no history of recent flares of ITP and patient had normal platelet counts following his splenectomy 4\u00a0years ago. He received two doses of IVIG and oral dexamethasone for 4\u00a0days with gradual improvement in platelet counts.<\/jats:p>\n                <jats:p>Case #3: 59\u00a0year old female with past medical history of chronic ITP secondary to SLE was admitted for bloody diarrhea 2\u00a0days after receiving her first dose of Johnson and Johnson COVID-19 vaccine. Physical exam was unremarkable. A complete blood test showed platelet count of 64\u2009\u00d7\u200910<jats:sup>9<\/jats:sup>\/L which dropped to 27\u2009\u00d7\u200910<jats:sup>9<\/jats:sup>\/L during hospital course. She received oral dexamethasone for 4\u00a0days with improvement in platelet counts.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>COVID-19 vaccination induced ITP has been recently acknowledged. However, given very few cases and limited data, currently there are no guidelines for management of ITP caused by COVID-19 vaccine as well as vaccination of people with predisposing conditions.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s40164-021-00235-0","type":"journal-article","created":{"date-parts":[[2021,7,15]],"date-time":"2021-07-15T09:03:48Z","timestamp":1626339828000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":41,"title":["COVID-19 vaccination associated severe immune thrombocytopenia"],"prefix":"10.1186","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6968-1703","authenticated-orcid":false,"given":"Syed Raza Ali","family":"Shah","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sherpa","family":"Dolkar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacob","family":"Mathew","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Prakash","family":"Vishnu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,7,15]]},"reference":[{"issue":"11","key":"235_CR1","doi-asserted-by":"publisher","first-page":"2386","DOI":"10.1182\/blood-2008-07-162503","volume":"113","author":"F Rodeghiero","year":"2009","unstructured":"Rodeghiero F, et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood. 2009;113(11):2386\u201393.","journal-title":"Blood"},{"key":"235_CR2","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1016\/j.ijid.2020.07.085","volume":"99","author":"P David","year":"2020","unstructured":"David P, Shoenfeld Y. ITP following vaccination. Int J Infect Dis. 2020;99:243\u20134.","journal-title":"Int J Infect Dis"},{"key":"235_CR3","unstructured":"https:\/\/www.fda.gov\/news-events\/press-announcements\/fda-issues-emergency-use-authorization-third-covid-19-vaccine. Accessed 27 Feb 2021."},{"issue":"5","key":"235_CR4","doi-asserted-by":"publisher","first-page":"534","DOI":"10.1002\/ajh.26132","volume":"96","author":"E-J Lee","year":"2021","unstructured":"Lee E-J, et al. Thrombocytopenia following Pfizer and Moderna SARS-CoV-2 vaccination. Am J Hematol. 2021;96(5):534\u20137.","journal-title":"Am J Hematol"},{"key":"235_CR5","unstructured":"https:\/\/www.usatoday.com\/story\/news\/health\/2021\/01\/06\/death-florida-doctor-following-pfizer-covid-19-vaccine-under-investigation-gregory-michael\/6574414002\/. Accessed 06 Jan 2021."},{"issue":"2\u20133","key":"235_CR6","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1007\/s12026-014-8597-x","volume":"60","author":"C Perricone","year":"2014","unstructured":"Perricone C, et al. Immune thrombocytopenic purpura (ITP) associated with vaccinations: a review of reported cases. Immunol Res. 2014;60(2\u20133):226\u201335.","journal-title":"Immunol Res"},{"issue":"7","key":"235_CR7","doi-asserted-by":"publisher","first-page":"675","DOI":"10.1177\/0961203316686406","volume":"26","author":"A Watad","year":"2017","unstructured":"Watad A, et al. Autoimmune\/inflammatory syndrome induced by adjuvants (Shoenfeld\u2019s syndrome)\u2014an update. 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Is MMR immunization safe in chronic Idiopathic thrombocytopenic purpura? Arch Dis Child. 2008;93(4):354\u20135.","journal-title":"Arch Dis Child"},{"issue":"6","key":"235_CR11","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2016-0124","volume":"138","author":"U Hamiel","year":"2016","unstructured":"Hamiel U, et al. Recurrent immune thrombocytopenia after influenza vaccination: a case report. Pediatrics. 2016;138(6): e20160124.","journal-title":"Pediatrics"},{"issue":"3","key":"235_CR12","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1136\/adc.84.3.227","volume":"84","author":"E Miller","year":"2001","unstructured":"Miller E, et al. Idiopathic thrombocytopenic purpura and MMR vaccine. Arch Dis Child. 2001;84(3):227\u20139.","journal-title":"Arch Dis Child"},{"issue":"5","key":"235_CR13","doi-asserted-by":"publisher","first-page":"1158","DOI":"10.4161\/hv.23601","volume":"9","author":"V Cecinati","year":"2013","unstructured":"Cecinati V, et al. Vaccine administration and the development of immune thrombocytopenic purpura in children. Hum Vaccines Immunother. 2013;9(5):1158\u201362.","journal-title":"Hum Vaccines Immunother"}],"container-title":["Experimental Hematology &amp; Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40164-021-00235-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40164-021-00235-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40164-021-00235-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,15]],"date-time":"2021-07-15T09:12:37Z","timestamp":1626340357000},"score":1,"resource":{"primary":{"URL":"https:\/\/ehoonline.biomedcentral.com\/articles\/10.1186\/s40164-021-00235-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,15]]},"references-count":13,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["235"],"URL":"https:\/\/doi.org\/10.1186\/s40164-021-00235-0","relation":{},"ISSN":["2162-3619"],"issn-type":[{"value":"2162-3619","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,15]]},"assertion":[{"value":"1 June 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 July 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 July 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Saint Michael Medical Center Ethics Committee approved the study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Informed consent was taken from all three patients.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"42"}}