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Letters to the Editor
strategies used successfully include eltrombopag and mycophenolate mofetil. Further data will be needed to understand the durability of these responses.
We anticipate that there may be cases along a spectrum of clinical presentations between vaccine-induced immune-mediated thrombotic thrombocytopenia and vaccine-associated ITP, as have already been noted else- where.15 In our cohort, overlapping characteristics have not yet been identified, and all six patients with samples tested were negative for anti-PF4 antibodies.
Both local and international registries are currently col- lecting data that will be useful for investigating treatment strategies and clinical outcomes for patients developing ITP following COVID-19 vaccination.
Philip Young-Ill Choi,1,2 Danny Hsu,3 Huyen Anh Tran,4 Chee Wee Tan,5 Anoop Enjeti,6 Vivien Mun Yee Chen,7,8 Beng Hock Chong,9 Jennifer Curnow,10 Dominic Pepperell11 and Robert Bird12
1The Canberra Hospital, Canberra, Australian Capital Territory; 2John Curtin School of Medical Research, Australian National University, Canberra, Australian Capital Territory; 3Liverpool Hospital, Liverpool, New South Wales; 4The Alfred Hospital, Melbourne, Victoria; 5Royal Adelaide Hospital, Adelaide, South Australia; 6Calvary Mater Hospital, Newcastle, New South Wales; 7ANZAC Research Institute, University of Sydney, Sydney, New South Wales; 8Department of Haematology, Concord Repatriation and General Hospital, Sydney, New South Wales; 9NSW Health Pathology, St George Hospital, University NSW, Sydney, New South Wales; 10Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales; 11Fiona Stanley Hospital, Perth, Western Australia and 12Princess Alexandra Hospital, Brisbane, Queensland, Australia
Correspondence:
PHILIP YOUNG-ILL CHOI - phil.choi@act.gov.au doi:10.3324/haematol.2021.279442
Received: June 15, 2021.
Accepted: August 2, 2021.
Pre-published: August 26, 2021.
Disclosures: no conflicts of interest to disclose.
Contributions: RB and PY-LC designed the study, analysed the data, and wrote the manuscript; DH, HAT, CWT, AE, VMYC, BHC, JC and DP reviewed and edited the manuscript.
Acknowledgments: the authors would like to thank Drs Fernando
Roncolato, Jock Simpson, Angeline Josie, Kate Melville, Susan Maccallum and Kim Cartwright for their contributions to this work.
References
1. Greinacher A, Thiele T, Warkentin TE, Weisser K, Kyrle PA, Eichinger S. Thrombotic thrombocytopenia after ChAdOx1 nCov-19 vaccination. N Engl J Med. 2021;384(22):2092-2101.
2. Gerber GF, Yuan X, Yu J, et al. COVID-19 vaccines induce severe hemol- ysis in paroxysmal nocturnal hemoglobinuria. Blood. 2021;137(26):3670- 3673.
3. Patel SU, Khurram R, Lakhani A, Quirk B. Guillain-Barre syndrome fol- lowing the first dose of the chimpanzee adenovirus-vectored COVID-19 vaccine, ChAdOx1. BMJ Case Rep. 2021;14(4):e242956.
4. Torjesen I. Covid-19: first UK vaccine safety data are “reassuring,” says regulator. BMJ. 2021;372:n363.
5. Miller E, Waight P, Farrington CP, Andrews N, Stowe J, Taylor B. Idiopathic thrombocytopenic purpura and MMR vaccine. Arch Dis Child. 2001;84(3):227-229.
6. Lee E-J, Cines DB, Gernsheimer T, et al. Thrombocytopenia following Pfizer and Moderna SARS-CoV-2 vaccination. Am J Hematol. 2021;96(5):534-537.
7. Cines DB, Bussel JB, Liebman HA, Luning Prak ET. The ITP syndrome: pathogenic and clinical diversity. Blood. 2009;113(26):6511-6521.
8. Kuter DJ. Exacerbation of immune thrombocytopenia following Covid- 19 vaccination. Br J Haematol. 2021;195(3):365-370.
9. Simpson CR, Shi T, Vasileiou E, et al. First-dose ChAdOx1 and BNT162b2 COVID-19 vaccines and thrombocytopenic, thromboembol- ic and hemorrhagic events in Scotland. Nat Med. 2021;27(7):1290-1297.
10. Nazy I, Sachs UJ, Arnold DM, et al. Recommendations for the clinical and laboratory diagnosis of VITT against COVID-19: communication from the ISTH SSC Subcommittee on Platelet Immunology. J Thromb Haemost. 2021;19(6):1585-1588.
11. Rodeghiero F, Stasi R, Gernsheimer T, et al. Standardization of terminol- ogy, definitions and outcome criteria in immune thrombocytopenic pur- pura of adults and children: report from an international working group. Blood. 2009;113(11):2386-2393.
12. Neunert C, Terrell DR, Arnold DM, et al. American Society of Hematology 2019 guidelines for immune thrombocytopenia. Blood Adv. 2019;3(23):3829-3866.
13. Pottegård A, Lund LC, Karlstad Ø, et al. Arterial events, venous throm- boembolism, thrombocytopenia, and bleeding after vaccination with Oxford-AstraZeneca ChAdOx1-S in Denmark and Norway: population based cohort study. BMJ. 2021;373:n1114.
14. Arnold DM, Nazy I, Clare R, et al. Misdiagnosis of primary immune thrombocytopenia and frequency of bleeding: lessons from the McMaster ITP Registry. Blood Adv. 2017;1(25):2414-2420.
15. Scully M, Singh D, Lown R, et al. Pathologic antibodies to platelet factor 4 after ChAdOx1 nCoV-19 vaccination. N Engl J Med. 2021; 384(23):2202-2211.
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