■长春新碱治疗可有效治疗COVID-19疫苗接种后的难治性免疫性血小板减少症(ITP)。我们的病例报告强调需要进一步研究,以建立COVID-19疫苗相关ITP的标准管理指南。
■成人免疫性血小板减少症(ITP)可作为几种病毒感染后的罕见并发症或疫苗接种后的罕见不良事件或并发症发生。在本文中,我们报道了一例39岁男性患者,患有重度难治性ITP,该患者在接受第三剂(加强剂)COVID-19疫苗(BNT162b2,Pfizer-BioNTech)4周后开始治疗.他每天口服地塞米松40mg,持续4天,然后以1mg/kg(每天85mg)的泼尼松,持续10天。在接下来的几周里,我们尝试了其他几种疗法来治疗他的ITP,包括抗RhD免疫球蛋白,which,不幸的是,导致中度溶血,需要输注充血红细胞,静脉注射免疫球蛋白(以亚治疗剂量0.4g/kg仅1天,因为它是不可用的),利妥昔单抗,还有Eltrombopag.病人,不幸的是,对任何这些治疗都没有反应。这是开始用长春新碱2mg每周3周的挽救治疗的指标。患者的血小板计数在长春新碱的第三周开始显著增加,并在4周后恢复正常。我们回顾了调查结果,临床特征,以及文献中报道的关于COVID-19疫苗诱导的ITP的管理方法。需要进行更深入的研究,以划定管理此类案件的标准准则。这份报告强调了诉诸长春新碱和艾曲波帕作为与COVID-19疫苗相关的严重和难治性ITP的绝佳选择的重要性。
UNASSIGNED: Vincristine therapy can be effective in
refractory Immune thrombocytopenia (ITP) following COVID-19 vaccination. Our
case report highlights the need for further research to establish standard management guidelines for COVID-19-vaccine-associated ITP.
UNASSIGNED: Adult immune thrombocytopenia (ITP) can occur as a rare complication following several viral infections or a rare adverse event or complication of vaccination. In this paper, we report a
case of a 39-year-old male patient with severe
refractory ITP that began 4-weeks after receiving his third (booster) dose of the COVID-19 vaccine (BNT162b2, Pfizer-BioNTech). He was given oral dexamethasone 40 mg daily for 4 days followed by prednisone at 1 mg/kg (85 mg daily) for 10 days. In the following weeks, we attempted several other lines of therapy to treat his ITP, including anti-RhD immunoglobulin, which, unfortunately, caused moderate hemolysis requiring packed red blood cell transfusion, intravenous immunoglobulin (given at a subtherapeutic dose of 0.4 g/kg for only 1 day since it was not available), rituximab, and eltrombopag. The patient, unfortunately, showed no response to any of these treatments. This was an indicator to initiate salvage therapy with vincristine 2 mg weekly for 3 weeks. The patient\'s platelet count started to increase remarkably during the third week of vincristine and normalized after 4 weeks. We review the findings, clinical characteristics, and management approaches that were reported in the literature regarding COVID-19-vaccine-induced ITP. More in-depth research is needed to delineate standard guidelines for the management of such cases. This report underscores the importance of resorting to vincristine and eltrombopag as great options for severe and
refractory ITP related to the COVID-19 vaccine.