scholarly journals A Relapsing Immune Thrombocytopenia Case in a Patient Following COVID-19 Vaccination

2021 ◽  
Author(s):  
Burcin Meryem Atak Tel ◽  
Gizem Kahveci ◽  
Tuba Taslamacioglu Duman ◽  
Özge Kurtkulagi ◽  
Satilmis Bilgin ◽  
...  
Keyword(s):  
Immune Thrombocytopenia ◽  
Full Recovery ◽  
Dexamethasone Treatment ◽  
Viral Vaccine ◽  
History Of ◽  
Viral Vaccines

AbstractThere are several vaccines developed against COVID-19 infection. Inactivated viral vaccines are usually well tolerated. We aimed to present a relapsing immune thrombocytopenia case following inactive COVID-19 vaccine. Here we report a case of relapsing immune thrombocytopenia following inactivated viral vaccine against COVID-19 in a 60-year-old woman with a history of immune thrombocytopenia. The patient responded well to dexamethasone treatment and was discharged from the hospital with full recovery. We suggest that physicians seek the history of a recent inactivate COVID-19 vaccine shot in patients with immune thrombocytopenia.

scholarly journals 241 Trends in the percentage of modified live, killed, and combination respiratory viral vaccines administered to beef calves offered for sale in summer video auctions from 2000 through 2018

2020 ◽  
Vol 98 (Supplement_3) ◽  
pp. 9-10
Author(s):  
Maggie J Smith ◽  
Mike E King ◽  
Karol E Fike ◽  
Esther D McCabe ◽  
Glenn M Rogers ◽  
...  
Keyword(s):  
Trend Test ◽  
Fort Worth ◽  
Single Gender ◽  
Beef Calves ◽  
Vaccine Type ◽  
Viral Vaccine ◽  
Viral Vaccines ◽  
Dramatic Shift ◽  
Armitage Trend Test

Abstract The objective of this study was to identify trends in the percentage of type of respiratory viral vaccines administered to lots of beef calves offered for sale in summer video auctions from 2000 through 2018. There were 59,762 lots of single-gender beef calves (7,167,352 total calves) offered for sale in 145 summer video auctions during these years. Information describing calf lots was obtained from the auction service (Superior Livestock Auction, Fort Worth, TX) which included named vaccines administered to the lot. Named 4- or 5-way respiratory viral vaccines were classified into three groups based on the type of antigens they contained: all modified live antigens (MLV), all killed antigens (KILLED), and a combination of modified live and killed antigens (COMBO). The Cochran-Armitage Trend Test was used to quantify the significance of a trend in the usage of each respiratory viral vaccine type. There was an increase (P < 0.0001) in the percentage of MLV vaccines given to beef calf lots from 2000 (39.7%) through 2018 (88.9%). At the same time, the percentages of both KILLED and COMBO vaccines administered to lots of beef calves declined (P < 0.0001 and P < 0.0001, respectively). In 2000, 31.2% and 29.1% of the total respiratory viral vaccines given to beef calf lots were KILLED or COMBO vaccines, respectively. By 2018, only 4.7% of respiratory viral vaccines were KILLED, and only 6.4% were COMBO vaccines. This dramatic shift indicates an industry trend towards increasing MLV vaccine utilization compared with declining usage of KILLED and COMBO vaccines. This trend may be a result of MLV vaccine approval for use in calves nursing pregnant cows.

scholarly journals Immune Thrombocytopenia Associated with COVID-19 - Case Series

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 13-14
Author(s):  
Ramil Fatkhullin ◽  
Vasily Shuvaev
Keyword(s):  
Immune Thrombocytopenia ◽  
Meta Analysis ◽  
Case Series ◽  
Cervix Uteri ◽  
First Episode ◽  
High Dose ◽  
Platelet Response ◽  
Pulmonary Infiltrates ◽  
High Dose Dexamethasone ◽  
History Of

Increased numbers of COVID-19 infection make the study of its systemic manifestations more and more important. Despite of SARS-Cov-2 main clinical respiratory syndrome other clinical infection signs as immune thrombocytopenia without respiratory failure were identified. We have seen case series of patients with thrombocytopenia and active COVID-19 infection during present epidemic outbreak. Patient 1, female, 31 years old was admitted at our hospital with ecchymoses, epistaxis, gingival hemorrhage and metrorrhagia. There were also signs of COVID-19 infection - fever up to 40oC, short of breathes with room air. The pulmonary infiltrates about to 25% were revealed by CT scan. The CBC parameters were as follows: WBC 8.9x109/l, Hb 11,2 g/dl, PLT 3 x109/l by microscopy. The patient was treated with high-dose dexamethasone 40 mg QD for 4 days. The treatment resulted to stable complete platelet response as 189x109/l in fourteen days after start of therapy. At that time, the cancer in situ of cervix uteri there was revealed by gynecologic examination, that was successfully local treated. Patient 2, female 30 years old presented epistaxis, metrorrhagia, cutaneous and gingival hemorrhagic syndrome as previous patient. There were WBC 6.4x109/l, Hb 12,6 g/dl, PLT 3x109/l by microscopy in CBC. She had no respiratory signs and abnormality in pulmonary CT. The COVID-19 infection was identified by PCR and antibody screening. The patient also received high-dose dexamethasone 40 mg QD for 4 days and yielded of platelet elevation to 25x109/l with no hemorrhagic syndrome in five days of treatment. Patient 3, female 68 years old with chronic course of immune thrombocytopenia and resistance to glucocorticoid, after splenectomy and presence of HBsAg. All relapses of thrombocytopenia in this patient were associated with virus infection. The first episode was in 2009, patient was treated with glucocorticoid with no effect. The complete platelet response was achieved after splenectomy. The relapse occurred in 2015 and was associated with acute respiratory distress syndrome (probably H7N9 flu). There treatment with prednisone 1 mg/day resulted to complete platelet response. At present time, the COVID-19 infection on this patient manifested with 75% of pulmonary volume lesions. At the recovery (25% of pulmonary infiltrates) the relapse of immune thrombocytopenia with cutaneous bleeding occurred. In CBC there were WBC 5.9x109/l, Hb 15,1 g/dl, PLT 5x109/l by microscopy. Given that history of therapy we treated this patient with high-dose dexamethasone 40 mg QD for 4 days and romiplostime 2 mqg/kg. The complete resolution of hemorrhagic signs and platelet response (65x109/l) was reached in seven days of treatment. Discussion. The virus-associated thrombocytopenia is usual in common practice. In recent COVID-19 infection outcome meta-analysis (G. Lippi et al. Clinica Chimica Acta 506 (2020) 145-148) the platelet count was significantly lower in severe course of disease. The presence of platelet below the lower limit was associated with fivefold of risk of severe COVID-19 and was a factor of mortality. The platelet decline could be as sign of disease worsening at one hand and have an own risk of mortality by bleeding at other hand. There is a need for guideline to thrombocytopenia management in COVID-19 patients. Now we are continuing to search and include the patients with COVID-19 infection and thrombocytopenia in our study. Disclosures Shuvaev: Novartis:Honoraria, Speakers Bureau;BMS:Honoraria, Speakers Bureau;Pfizer:Honoraria, Speakers Bureau.

scholarly journals Immune Thrombocytopenia

Hematology ◽  
2010 ◽  
Vol 2010 (1) ◽  
pp. 377-384 ◽  
Author(s):  
Adam Cuker ◽  
Douglas B. Cines
Keyword(s):  
Immune Thrombocytopenia ◽  
Therapeutic Decision ◽  
Platelet Destruction ◽  
Aggressive Therapy ◽  
Pulse Dose ◽  
Thrombopoietin Receptor ◽  
History Of ◽  
Associated Conditions ◽  
Therapeutic Decision Making

Abstract Immune thrombocytopenia (ITP) comprises a heterogeneous group of disorders characterized by autoimmune-mediated platelet destruction and impairment of thrombopoiesis. ITP may occur in the absence of an evident predisposing etiology (primary ITP) or secondary to a growing list of associated conditions (secondary ITP), and must be differentiated from other causes of thrombocytopenia. This review focuses on primary ITP in adults. The traditional goal of therapy in this population is to achieve a hemostatic platelet count of 30 × 109/L or above for most patients while minimizing treatment-related morbidity. This approach has been called into question by the recent advent of well-tolerated and effective agents for the management of ITP, including pulse-dose dexamethasone, rituximab, and the thrombopoietin receptor agonists. Recent studies suggest the potential for aggressive therapy at the time of diagnosis to alter the natural history of ITP and point to the importance of quality-of-life considerations in therapeutic decision making.

scholarly journals Scrub typhus with multi-organ dysfunction syndrome and immune thrombocytopenia: a case report and review of the literature

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Weijia Li ◽  
Lei Huang ◽  
Weixing Zhang
Keyword(s):  
Organ Dysfunction ◽  
Immune Thrombocytopenia ◽  
Skin Infection ◽  
Scrub Typhus ◽  
Case Presentation ◽  
Tsutsugamushi Disease ◽  
History Of ◽  
The Right ◽  
Insect Bites ◽  
Multi Organ Dysfunction Syndrome

Abstract Background Scrub typhus is an acute infectious zoonotic disease caused by Orientia tsutsugamushi. Multi-organ dysfunction secondary to scrub typhus is hard to diagnose and has a high mortality rate. Only one case of scrub typhus with multi-organ dysfunction syndrome and immune thrombocytopenia has been reported thus far. In this study, we report a second case of scrub typhus with multi-organ dysfunction syndrome and immune thrombocytopenia, and we summarize its diagnosis and treatment. Case presentation A 43-year-old Han Chinese woman, a sanitation worker, was admitted to our hospital after 7 days of a skin infection and 5 days of a sore throat with fever and dizziness. A physical examination revealed the presence of an eschar on the right side of her neck. She had a history of insect bites during her sanitation work. A diagnostic evaluation identified scrub typhus as the primary illness, which was associated with multi-organ dysfunction syndrome and immune thrombocytopenia. She recovered completely after 15 days of treatment and extensive symptomatic supportive care. Conclusion We report a second case of tsutsugamushi disease with multi-organ dysfunction syndrome and immune thrombocytopenia, which resolved after treatment and extensive care.

scholarly journals A case of Aggregatibacter actinomycetemcomitans endocarditis presenting as quadriceps myositis

2012 ◽  
Vol 4 (1) ◽  
pp. 14 ◽  
Author(s):  
Angeline Reid ◽  
Katerina Liew ◽  
Peter Stride ◽  
Robert Horvath ◽  
Jonathan Hunter ◽  
...  
Keyword(s):  
Dental Care ◽  
Transoesophageal Echocardiography ◽  
Aggregatibacter Actinomycetemcomitans ◽  
Full Recovery ◽  
History Of

An 80 year old female was admitted with an eight week history of fever associated with painful swelling of her right thigh, and a long history of poor dentition. Culture of blood stained fluid aspirated from the abscess grew Aggregatibacter actinomycetemcomitans (Aa) sensitive to ampicillin and cephalosporins. Transoesophageal echocardiography indicated endocarditis. Four weeks treatment with intravenous ceftriaxone and appropriate dental care was followed by full recovery.

Immune Thrombocytopenia

Hematology ◽  
2010 ◽  
Vol 2010 (1) ◽  
pp. 377-384 ◽  
Author(s):  
Adam Cuker ◽  
Douglas B. Cines
Keyword(s):  
Immune Thrombocytopenia ◽  
Therapeutic Decision ◽  
Platelet Destruction ◽  
Aggressive Therapy ◽  
Pulse Dose ◽  
Thrombopoietin Receptor ◽  
History Of ◽  
Associated Conditions ◽  
Therapeutic Decision Making

Immune thrombocytopenia (ITP) comprises a heterogeneous group of disorders characterized by autoimmune-mediated platelet destruction and impairment of thrombopoiesis. ITP may occur in the absence of an evident predisposing etiology (primary ITP) or secondary to a growing list of associated conditions (secondary ITP), and must be differentiated from other causes of thrombocytopenia. This review focuses on primary ITP in adults. The traditional goal of therapy in this population is to achieve a hemostatic platelet count of 30 × 109/L or above for most patients while minimizing treatment-related morbidity. This approach has been called into question by the recent advent of well-tolerated and effective agents for the management of ITP, including pulse-dose dexamethasone, rituximab, and the thrombopoietin receptor agonists. Recent studies suggest the potential for aggressive therapy at the time of diagnosis to alter the natural history of ITP and point to the importance of quality-of-life considerations in therapeutic decision making.

Effect of Pregnancy in Women with a History of Primary Immune Thrombocytopenia Considered As Cured

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2552-2552
Author(s):  
Thibault Comont ◽  
Guillaume Moulis ◽  
Karen Delavigne ◽  
Pierre Cougoul ◽  
Olivier Parant ◽  
...  
Keyword(s):  
Platelet Count ◽  
Complete Remission ◽  
Epidural Analgesia ◽  
Pregnant Women ◽  
Immune Thrombocytopenia ◽  
Specific Treatment ◽  
Severe Bleeding ◽  
Adult Women ◽  
History Of ◽  
The Impact

Abstract Immune thrombocytopenia (ITP) is an autoimmune disease that occurs in young women. Pregnancy is a well-known risk factor for developing newly diagnosed ITP as well as for inducing disease flares in patients with current ITP. However, the impact of pregnancy in women with an old history of ITP, considered as cured, has not been assessed. The aim of this study was to describe the course of ITP in pregnant women with an ITP in complete remission (platelets count >100x109/L and absence of bleeding symptoms) for at least 5 years without any ITP treatment. We retrospectively selected all pregnant women with delivery at Toulouse University Hospital, South of France, between 2010 and 2015 with a hospital discharge code of ITP (international classification of diseases; version 10 code D69.3). This code has a sensitivity of 81.2% and a positive predictive value of 89.8% in this database. All medical charts were reviewed to confirm the diagnosis of ITP. We included adult women (≥18 years) with a diagnosis of primary ITP according to French guidelines (platelet count <150 x 109 /L and exclusion of other causes of thrombocytopenia, especially other causes of thrombocytopenia during pregnancy) in complete remission for at least 5 years. We identified 50 pregnancies in 39 ITP patients during the study period. Eleven pregnancies occurred in 10 patients in long-term complete remission of ITP at the time of pregnancy onset. Baseline characteristics were: median age at ITP diagnosis: 21 years (range: 4-29); median age at pregnancy onset:32 years (range: 26-34; history of ITP during a previous pregnancy: 1; history of bleeding: 4 (36.4%); previous treatment for ITP: 8 (72.7%), corticosteroids-CS (5), CS and intravenously immunoglobulin-IVIg (3), splenectomy (4), dapsone (1); last median platelet count before pregnancy: 170x109/L (range: 118-363). Platelets count decreased below 100x109/L in 3 pregnancies (27.2%) from the first trimester for one patient, from the second trimester for one other and from the third trimester for the last one, with a nadir of 3, 39 and 87 (x109/L) respectively. One of them experienced a severe bleeding (grade 3 according to the International Working Group bleeding classification). All thrombocytopenic patients required treatment during pregnancy: CS+IVIg for 2 (one for bleeding and one to allow epidural analgesia) and IVIg for the other (to allow epidural analgesia). For these 3 women, the median platelet count at delivery was 128 (range: 38-159) and consequently only 2 of them could have epidural analgesia. No bleeding during delivery was observed. Transient thrombocytopenia occurred in 2 newborns. Primary ITP considered as cured may relapse during pregnancy and may induce severe bleeding requiring specific treatment. A tight monitoring should be proposed to all pregnant women with a history of primary ITP, even after several years of complete remission. Disclosures Récher: Celgene, Sunesis, Amgen, Novartis, Chugai: Membership on an entity's Board of Directors or advisory committees, Research Funding.

The Natural History of Adult Trigger Thumb

1993 ◽  
Vol 18 (2) ◽  
pp. 247-248 ◽  
Author(s):  
C. B. SCHOFIELD ◽  
N. D. CITRON
Keyword(s):  
Natural History ◽  
Average Duration ◽  
Adult Patients ◽  
Full Recovery ◽  
Trigger Thumb ◽  
Duration Of Symptoms ◽  
History Of ◽  
Average Loss ◽  
Functional Reduction

30 consecutive adult patients presenting with trigger thumb (31 thumbs) were entered prospectively into a study to determine the natural history of the condition. Five patients insisted on treatment and could not be followed to resolution, but the rest resolved spontaneously after an average duration of symptoms of 6.8 months (range 2–15). There was a small but non-functional reduction in movement of the thumb in some of the patients: six lost an average of 7° of abduction and ten had an average loss of opposition of 1.4 (Kapandji grade). The remaining patients made a full recovery.

scholarly journals Influence of Age on Treatment with Thrombopoietin Receptor Agonists in Patients with Immune Thrombocytopenia; A Retrospective Multicenter Study

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2361-2361
Author(s):  
Maria Luisa Lozano ◽  
Maria Eva Mingot-Castellano ◽  
María Perera ◽  
Isidro Jarque ◽  
Rosa Maria Campos ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Older Patients ◽  
Immune Thrombocytopenia ◽  
Older Age ◽  
Vascular Events ◽  
Thrombotic Risk ◽  
Younger Patients ◽  
Thrombopoietin Receptor Agonists ◽  
Thrombopoietin Receptor ◽  
History Of

Background. Increasing age is a risk factor for vascular events but also for bleeding in immune thrombocytopenia (ITP). In elderly, meta-analysis of clinical trials of romiplostim (ROM) and eltrombopag (ELT) show that thrombopoietin receptor agonists (TPO-RA) are effective and safe with the exception of increased thromboembolic risk (Olney et al, 2011; Michel et al 2015). Objective. To analyze how age influences the selection of TPO-RA, bleeding and thrombotic risk, comorbidities, and therapeutic management of ITP patients in a real-world setting. Methods. We conducted a multicenter retrospective study that included 121 adult patients with primary ITP from 19 secondary and tertiary Spanish hospitals who had initiated long-term therapy with ROM or ELT between January 2012 and December 2014. Information was collected from medical records (November 2016 to January 2018) to assess variables related to patient characteristics and outcomes of elderly (> 65 years; n=54) compared with younger individuals (n=67). Results. Patients included initiated TPO-RA (ROM, n=54; ELT, n=67) and maintained this therapy for a median time to collection of data of 35.2 months (1 to 67.3 months). The median age at diagnosis of elderly and younger cohorts was respectively 75 years (66-96 years), and 48 years (19-65 years). Older age was associated with a previous history of vascular events (VE) (P=0.049), with more patients receiving antithrombotic therapy (P=0.001), and with a non-significant trend towards increased risk of current VE under TPO-RA therapy (Table). During treatment, 15 patients experienced 17 VE (9 arterial, 8 venous); no association was found between risk for VE in patients under TPO-RA and past history of thromboembolic or ischemic events (P=0.727). Patients that were offered TPO-RA at younger ages presented at diagnosis with significantly lower platelet counts, and increased cumulative bleeding score (Page et al, 2007) (P=0.003, and P=0.034) than elderly ones. Younger patients also had significantly higher visceral bleeding rates at the onset of TPO-RA therapy (P=0.042) and had increased requirement for hospital care (emergency treatment or hospital admission) both six months before and after the start of TPO-RA (P=0.016, and P=0.002, respectively). Older age was associated with comorbidities such as hypertension and diabetes (P<0.001), and with decreased exposure to splenectomy (P=0.002). In patients over 65 years experiencing VE on TPO-RA, a significant association with previous neoplasia was observed vs. those without that complication (50% vs. 2.2%, P<0.001), whereas in younger patients VE during TPO-RA therapy was only associated with previous splenectomy (100% vs. 33%, P=0.001). There was a trend towards a preferential use of ELT in older patients. While slightly higher platelet response rates to TPO-RA were seen among patients >65 versus ≤65 years, however a more conservative management in terms of discontinuation of therapies was confirmed. Therefore, the rate of tapering off TPO-RA was significantly lower in those >65 years (P=0.028), although the proportion of patients that achieved therapy free response (TFR) (platelet count >50x109/l for at least 6 months) upon discontinuation was similar in both groups (Table). Conclusion. The management of older patients with chronic ITP is still challenging, and widespread effort is made to avoid potential complications such as those related to splenectomy. Our study reflects that the introduction of TPO-RAs has caused a change in the outcomes of these patients. The increased awareness of the unfavorable conditions that are present in this population induces a preferential use of TPO-RAs in elderly patients with a lower bleeding history than in younger patients. Although these drugs associate with a potential risk of increased thrombotic risk, our data indicate that past thrombotic history does not predispose to the development of VE; rather neoplasia in elderly patients, and splenectomy at younger ages are factors that increase the likelihood to suffer from these events. The compromise towards effective therapies in these fragile patients associates with low discontinuation of TPO-RA to test for TFR, although once tapered off, sustained platelet responses are similar to those in younger patients. Disclosures Mingot-Castellano: Novonordisk: Consultancy; Sobi: Consultancy; Amgen: Consultancy; Takeda: Consultancy; Bayer: Consultancy; CSL Behring: Consultancy; Roche: Consultancy; Novartis: Consultancy. Jarque:Abbie: Consultancy, Speakers Bureau; Alexion: Consultancy, Speakers Bureau; Amgen: Consultancy, Speakers Bureau; Bristol-Myers Squibb: Consultancy, Speakers Bureau; Celgene: Consultancy, Speakers Bureau; CellTrion: Consultancy; Gilead: Consultancy, Speakers Bureau; Grifols: Consultancy; Janssen: Consultancy, Speakers Bureau; MSD: Consultancy, Speakers Bureau; Novartis: Consultancy, Speakers Bureau; Pfizer: Consultancy, Speakers Bureau; Roche: Consultancy, Speakers Bureau; Servier: Speakers Bureau; Shionogi: Consultancy, Speakers Bureau; Shire: Consultancy, Speakers Bureau; Takeda: Consultancy, Speakers Bureau. Campos:Novartis: Speakers Bureau; Amgen: Speakers Bureau. Lopez Fernandez:Amgen: Consultancy, Speakers Bureau. Valcarcel:MSD: Consultancy, Honoraria, Speakers Bureau; Astellas: Consultancy, Honoraria, Speakers Bureau; JAZZ: Consultancy, Honoraria, Speakers Bureau; Pfizer: Consultancy, Honoraria, Speakers Bureau; Celgene: Consultancy, Honoraria, Speakers Bureau; Novartis: Consultancy, Honoraria, Speakers Bureau; Amgen: Consultancy, Honoraria, Speakers Bureau. Casado:Amgen: Consultancy, Speakers Bureau; Novartis: Consultancy, Speakers Bureau. Álvarez Roman:Takeda: Research Funding; Amgen: Consultancy, Speakers Bureau; Novartis: Consultancy, Speakers Bureau; Bayer: Consultancy, Speakers Bureau; Pfizer: Consultancy, Speakers Bureau; Roche: Consultancy, Speakers Bureau; CSL Behring: Consultancy, Speakers Bureau; NovoNordisk: Consultancy, Speakers Bureau; Sobi: Consultancy, Speakers Bureau.

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