Table 1.
Characteristics of included studies.
| Author, Year | Age | Sex | Presenting Features | Time to Symptom Onset or Presentation after Vaccine (in Days) | Vaccine Dose | Comorbidities | Admission Platelet Counts or Nadir (Whichever Is Reported First) | Treatment Received | Outcomes | Second Dose, If Applicable |
|---|---|---|---|---|---|---|---|---|---|---|
| Cases due to Ad26.COV2-S (Johnson & Johnson vaccine) | ||||||||||
| Shah et al., 2021 [4] | 59 | F | Abdominal cramps, diarrhea | 2 | - | Chronic ITP and SLE (prior flare-up 2 years ago after Shingrix vaccine) | 64 × 103/μL | Dexamethasone | Discharged | No comment |
| Banerjee et al., 2021 [9] | 63 | F | Bleeding gums | 14 | - | Cervical cancer s/p hysterectomy | 2 × 103/μL | Platelets, Prednisone, IVIG, and dexamethasone | Discharged on day 5 | - |
| Cases due to ChAdOx1 nCoV-19 vaccine | ||||||||||
| Scanvion et al., 2021 [10] | 62 | F | Asymptomatic | 6 | First dose | ITP, overweight, HLD, HTN | 60 × 103/μL | None | No hospitalization | No comment |
| Scanvion et al., 2021 [10] | 45 | F | Asymptomatic | 3 | First dose | ITP | 53 × 103/μL | None | No hospitalization | No comment |
| Candelli et al., 2021 [11] | 28 | M | Petechiae, oral bleed, fatigue, headache, fever | 1 | First dose | None | 4 × 103/μL (Lupus anticoagulant positive) | Four-day Dexamethasone course, once during hospitalization and once 10 days after discharge | Discharged after 4 days | No comment |
| Paulsen et al., 2021 [12] | 72 | M | Petechiae, hematomas | 11 | First dose | Radioiodine-treated autoimmune thyroiditis | <5 × 103/μL | Prednisolone, IVIG | Discharged | No comment |
| Paulsen et al., 2021 [12] | 71 | F | Petechiae, headache | 11 | First dose | Latent hyperthyroidism, breast cancer, stroke | <5 × 103/μL | Prednisolone followed by dexamethasone, IVIG, TPO-RA | Discharged but readmitted 7 days after | No comment |
| Paulsen et al., 2021 [12] | 66 | M | Petechiae, hyposphagma | 1 | First dose | HTN, mild thrombocytopenia | < 5 × 103/μL | Prednisolone | Discharged | No comment |
| Paulsen et al., 2021 [12] | 64 | F | Petechiae, epistaxis | 15 | First dose | HTN, COPD, hepatic steatosis | 6 × 103/μL | Prednisolone | Discharged | No comment |
| Gardellini et al., 2021 [13] | 63 | M | Hematomas, epistaxis | 14 | First dose | DM, HTN, HLD | 2 × 103/μL | Prednisone | Discharged | Second dose given after 9 weeks |
| Kim et al., 2021 [14] | 66 | F | Bruising, gum bleeding | 2 | First dose | None | 4 × 103/μL | Dexamethasone and IVIG | Discharged | No comment |
| Sivaramakrishnan et al., 2022 [15] | - (middle-aged) | F | Hemoptysis and menorrhagia | 11 (had been evaluated 30 days after first dose for similar complaints and was given platelets) | First and second doses | None | 10 × 103/μL | Prednisolone | Discharged with relapse after 3 weeks | - |
| Al-Ahmad et al., 2022 [16] | 56 | M | Admitted for partial small bowel obstruction | 14 | First dose | Primary ITP s/p splenectomy | 9 × 103/μL | IVIG and TPO-RA (refused steroids) | Discharged with a repeat dose of TPO-RA for worsening counts | No comment |
| Al-Ahmad et al., 2022 [16] | 63 | F | Petechiae | 10 | Second dose | Chronic ITP | 35 × 103/μL | None | Not admitted | No comment |
| Al-Ahmad et al., 2022 [16] | 28 | F | Petechiae, gum, and nosebleed | 10 | First dose | Chronic ITP (maintained on romiplostim and prednisolone) | 30 × 103/μL | Romiplostim was continued and prednisolone dose was increased | Not admitted | No comment |
| Al-Ahmad et al., 2022 [16] | 54 | F | Ecchymoses | 13 | First dose | None | 10 × 103/μL | Prednisolone and IVIG | Discharged after 6 days – readmitted 3 days later with counts of 10 × 103/μL | No comment |
| Al-Ahmad et al., 2022 [16] | 33 | F | Ecchymoses | 21 | First dose | None | 3 × 103/μL | IVIG, Prednisolone, and Romiplostim | Discharged after 7 days, was readmitted 26 days later with recurrence | No comment |
| Wong et al., 2022 [17] | 86 | M | Gingival bleeding, ecchymosis, and tongue blisters | 2 | First dose | NA | 4 × 103/μL | Dexamethasone, platelets, IVIG and Rituximab | Discharged | NA |
| Wong et al., 2022 [17] | 38 | F | Petechiae and purpura | 10 | First dose | NA | 3 × 103/μL | Prednisone and IVIG | Discharged | NA |
| Razzaq et al., 2021 [18] | 26 | M | Asymptomatic | 2 | First dose | Mild thrombocytopenia | 64 × 103/μL | Methylprednisolone and IVIG | Discharged | No comment |
| Uaprasert et al., 2022 [19] | 80 | M | Bleeding from bitten tongue | 19 | First dose | None | 14 × 103/μL | Dexamethasone, prednisolone, IVIG, TPO-RA | Improved | No comment |
| Uaprasert et al., 2022 [19] | 84 | M | Dizziness | 9 | First dose | Adrenal insufficiency due to adrenal histoplasmosis, cirrhosis, past HBV infection | 36 × 103/μL (HCV and HIV positive) | None | Improved | No comment |
| Uaprasert et al., 2022 [19] | 55 | F | Purpura and oral bleeding | 24 | First dose | HLD | 41 × 103/μL | None | Improved | No comment |
| Liao et al., 2021 [20] | 79 | M | Asymptomatic | 8 | First dose | Stroke | 2 × 103/μL | Hydrocortisone followed by prednisolone | Discharged after 12 days | No comment |
| Cases due to BNT162b2 vaccine | ||||||||||
| Ganzel et al., 2021 [21] | 53 | M | Epistaxis, purpura, petechiae | 14 | First dose | Obesity, DM, HTN | 1 × 103/μL | Dexamethasone and IVIG | Improved | Second dose not given |
| Tarawneh et al., 2021 [22] | 22 | M | Petechiae, gum bleeding | 3 | First dose | None | 2 × 103/μL (mild transaminitis, SSA-antibody which later normalized) | Dexamethasone, platelet transfusion, and IVIG | Discharged after 5 days | No comment |
| Fueyo-Rodriguez et al., 2021 [23] | 41 | F | Fever, tachycardia, nausea | 1 | First dose | HTN, hypothyroidism, pre-DM | 65 × 103/μL (elevated IgE and CRP) | Methylprednisolone, dexamethasone, and IVIG | Discharge after 5 days | No comment |
| Shah et al.,2021 [4] | 53 | M | Fever, chills, myalgia, petechiae | 8 | Second dose | Crohn’s disease | 2 × 103/μL | Dexamethasone and IVIG | Discharged | No comment |
| Shah et al.,2021 [4] | 67 | M | Generalized weakness, melena, petechiae | 2 | First dose | Seizures, atrial fibrillation, chronic ITP in remission | 2 × 103/μL | Platelet, IVIG and dexamethasone | Discharged | Second dose not advised |
| Jawed et al., 2021 [24] | 47 | F | Gum bleeding, epistaxis | 18 | First dose | Chronic ITP, Hypothyroidism secondary to Hashimoto’s thyroiditis | 1 × 103/μL | Platelet, IVIG | Discharged | No comment |
| King et al., 2021 [25] | 39 | F | Petechiae | 1 | Second dose | PCOS | 1 × 103/μL (elevated ESR) | Platelet, methylprednisolone, and IVIG | Discharged after 3 days | No comment |
| Gardellini et al., 2021 [13] | 27 | M | Hematomas, epistaxis | 10 | First dose | None | 1 × 103/μL | IVIG, prednisolon, dexamethasone | Discharged | No comment |
| Gardellini et al., 2021 [13] | 39 | F | Petechiae, ecchymosis | 6 | Second dose | Chronic ITP | 1 × 103/μL | IVIG-prednisone, TPO-RA | Not reported | No comment |
| Qasim et al., 2021 [26] | 28 | M | Petechiae and epistaxis | 2 | Second dose | ITP | 1 × 103/μL | IVIG and dexamethasone | Discharged on prednisolone taper | Not reporter |
| Shonai et al., 2021 [27] | 69 | M | Oral bleeding and hemoptysis | 10 | Second dose (had asymptomatic thrombocytopenia after first dose) | Well-controlled postoperative intestinal obstruction and hypopharyngeal cancers s/p permanent tracheal fistula surgery | 6 × 103/μL (H pylori antibody positive) | Prednisolone | Improved (refused hospitalization) | No comment |
| Krajewski et a., 2021 [28] | 74 | M | Hemorrhagic mucosal blisters and purpura | 1 | First dose | HTN | 2 × 103/μL | Platelet and Dexamethasone | No comment | No comment |
| Al-Ahmad et al., 2022 [16] | 19 | M | Mouth and nosebleed | 4 | Second dose | Chronic ITP (maintained on eltrombopag) | 4 × 103/μL | Methylprednisolone, prednisolone, and increased dose of eltrombopag | Left against medical advice | No comment |
| Idogun et al., 2021 [29] | 54 | F | Petechiae, ecchymosis, mucosal bleeding | 7 days after first dose but presented 5 days after second dose (21 days after symptom onset) | First and second doses | HTN, congenital epidermal dysplasia, overactive bladder, mild cognitive impairment, CKD and anxiety | 0 | Platelet, dexamethasone, IVIG | Discharged but was readmitted after 4 days | - |
| Hidaka et al., 2022 [30] | 53 | F | Shortness of breath | 14 days after second dose but had transient wheezing and purpura after first dose | First and second doses | Asthma, Vogt-Koyanagi-Harada disease, Hashimoto disease | 39 × 103/μL (Also had AIHA, lupus anticoagulant and ANA positive, hypocomplementemia, COVID IgG positive) | Prednisolone, blood transfusion (for Evans syndrome associated with SLE post-COVID vaccination) | Discharged | - |
| Al-Ahmad et al., 2022 [16] | 30 | F | Petechiae | 7 | First dose | Chronic migraine, depression, chronic ITP | 40 × 103/μL | None | Not admitted | No comment |
| Saito et al., 2022 [31] | 66 | F | Malaise, lymphadenopathy, fever, hematuria, oral bleeding, and purpura | 2 | First dose | None | <1 × 103/μL (positive antiplatelet glycoprotein IIb/IIIa antibodies, elevated inflammatory markers) | Platelet, IVIG, prednisolone, pulsed methylprednisolone, TPO-RA, danazol and vincristine | Discharged on day 22 | No comment |
| Pasin et al., 2022 [32] | 84 | M | Petechiae, gum bleeding | 5 | First dose | Localized bladder cancer, tremors, mild CKD, Atrial fibrillation on apixaban | 3 × 103/μL (SARS-CoV-2 negative; positive antiplatelet glycoprotein IIb/IIIa antibodies) | Platelet, IVIG and prednisone | Improved | None |
| Nakamura et al., 2022 [33] | 32 | F | Petechiae, oral bleeding | 5 | Second dose | None | <1 × 103/μL (Platelet associated GPIbα IgG) | Prednisolone | Discharged on day 12 | No comment |
| Al-Ahmad et al., 2022 [16] | 37 | F | Petechiae | 10 | Second dose | Primary ITP | 25 × 103/μL | Prednisolone | Improved | No comment |
| Al-Ahmad et al., 2022 [16] | 30 | M | Fatigue, petechiae, gum bleeding, epistaxis | 7 | First dose | Primary ITP (on eltrombopag) | 11 × 103/μL | Prednisolone, IVIG and eltrombopag | Discharged on day 2 | Allowed to take second dose with close follow-up |
| Al-Ahmad et al., 2022 [16] | 56 | F | Gum and nose bleeding | 7 | Second dose | HTN, DM | 2 × 103/μL | IVIG, prednisolone and TPO-RA | Discharged after 3 days but readmitted 2 weeks later | No comment |
| Ogai et al., 2021 [34] | 64 | F | Oral bleeding and petechiae | 2 | First dose | Chronic ITP | 1 × 103/μL | Prednisolone and IVIG | Improvement | No comment |
| Ogai et al., 2021 [34] | 61 | F | Petechiae | 17 | Second dose | Chronic ITP, Scleroderma and Sjogren syndrome | 1 × 103/μL | Platelet, Prednisolone and TPO-RA | Improvement | No comment |
| Battegay et al., 2021 [35] | 77 | M | Asymptomatic; petechiae on buccal mucosa | 8 | First dose | CAD, Atrial fibrillation, HTN (Had mild thrombocytopenia pre-vaccination) | 28 × 103/μL | IVIG, prednisone and TPO-RA | Improvement | Second dose under eltrombopag taper |
| Ghosh et al., 2022 [36] | 63 | F | Rash and easy bruising | 1 | Second dose | COPD, HTN, DM | 0 (positive for SS-A and scleroderma antibodies) | Dexamethasone, IVIG, TPO-RA, rituximab | Discharged | - |
| Akiyama et al., 2021 [37] | 20 | F | Subcutaneous hemorrhage | 12 | First dose | None | 16 × 103/μL | Prednisolone | Improved | No comment |
| Jasaraj et al., 2021 [38] | 67 | F | Petechiae, gum bleeding, epistaxis, subconjunctival hemorrhage | 2 | Second dose (also had symptoms 14 days after the first dose) | HTN, DM, hypothyroidism, depression, b12 deficiency, headaches | 3 × 103/μL | Prednisone, IVIG, platelet, ACA, rituximab, TPO-RA | Discharged on day 14 (received rituximab and TPO-RA outpatient) | - |
| Ghous et al., 2021 [39] | 69 | F | Bruising and gum bleeding | 14 | First dose | Cataract, SCC, BCC | 5 × 103/μL (AST and LDH were high) | Platelet, IVIG, dexamethasone, TPO-RA, vincristine, prednisone | Discharged with return to ER for iatrogenic thrombocytosis | No comment |
| Cases due to mRNA-1273 vaccine | ||||||||||
| Abuhelwa et al., 2021 [40] | 65 | F | Epistaxis and rash | 1 | First dose | None | 3 × 103/μL | Platelets, IVIG, dexamethasone, Rho immunoglobulins and TPO-RA | Discharged on day 14 | No comment |
| Prasad et al., 2021 [41] | 58 | M | Mucosal bleed, petechiae | 21 | First dose | HTN, DM | 3 × 103/μL (PF4 antibody was weakly positive but SRA negative) | Dexamethasone, platelets, IVIG, second relapse treated with platelets, IVIG, TPO-RA and fostamatinib | Discharged in 6 days but presented 5 days later with recurrence, and then again 10 days later | Refused |
| Ogai et al., 2021 [34] | 73 | F | Petechiae | 11 | First dose | HTN, HLD | 2 × 103/μL | Prednisolone, IVIG, and TPO-RA | Improvement | No comment |
| Chanut et al., 2022 [42] | 73 | F | Epistaxis, intra-buccal hemorrhage, and bruises | 7 | First dose | IgA monoclonal gammopathy of undetermined significance, HTN, HLD, hypothyroidism, glaucoma | 2 × 103/μL | IVIG | Discharged | Rechallenged with BNT162b2 vaccine with no relapse |
| Helms et al., 2021 [43] | 74 | M | Epistaxis and diffuse cutaneous purpura | 1 | First dose | HTN, Gout, HLD and nonischemic cardiomyopathy | 10 × 103/μL | Dexamethasone, IVIG, rituximab, TPO-RA | Discharged on day 5; readmitted on day 13 | No comment |
| Chong et al., 2022 [44] | 75 | F | Hemoptysis | 3 | First dose | Refractory lung adenocarcinoma on durvalumab | 7 × 103/μL (prior hepatitis B infection) | Platelets, prednisolone | Discharged on day 5 | Second dose not advised |
| Malayala et al., 2021 [45] | 60 | M | Purpura, nausea, vomiting, shortness of breath, leg edema, chest and abdominal pain | 1 | First dose | Hepatitis C infection, CKD-stage IV, HTN, HFrEF, smoker | 84 × 103/μL (With deranged LFTs – heavy hepatitis C viral load and cirrhosis) | None | Left against medical advice on day 3 of hospitalization | No comment |
| Gardellini et al., 2021 [13] | 24 | M | Petechiae | 21 | Second dose | None | 2 × 103/μL | IVIG and prednisone | Discharged on steroid taper | No comment |
| Julian et al., 2021 [46] | 72 | F | Rash, spontaneous oral bleeding, headache | 1 | First dose | DM, seasonal contact dermatitis, gout | 12 × 103/μL (prior parvovirus infection) | Dexamethasone, IVIG, ACA, rituximab, and platelets | No comment | No comment |
| Toom et al., 2021 [47] | 36 | F | Petechiae, easy bruising, bleeding gum, headache | 7 | First dose | Familial ITP | 3 × 103/μL (unlikely due to vaginal estrogen ring) | Dexamethasone and IVIG | Discharged | No comment |
| Shonai et al., 2021 [27] | 34 | F | Purpura | 21 | Second dose | None | 11 × 103/μL | Initially not treated, however, on 1 week follow- up, had worsened platelet count for which prednisolone and TPO-RA were given | Improved | - |
| Hines et al., 2021 [48] | 26 | F | Petechiae | 7 | First dose o | Irregular menses on OCPs | 19 × 103/μL (transaminitis present) | Prednisone, dexamethasone, and IVIG | Discharged on day 5 | No comment |
| Bennett et al., 2021 [49] | 32 | F | Petechiae and bruising | 11 | First dose | None – was currently pregnant at 9 weeks | 1 × 103/μL | Prednisone | Discharged on day 3 | No comment |
ACA: aminocaproic acid; AIHA: autoimmune hemolytic anemia; BCC: basal cell carcinoma; CAD: coronary artery disease; COPD: chronic obstructive pulmonary disease; CKD: chronic kidney disease; DM: diabetes; ER: emergency room; F: female; HFrEF: heart failure with reduced ejection fraction; HLD: hyperlipidemia; HTN: hypertension; HBV: hepatitis B virus; ITP: immune thrombocytopenic purpura; IVIG: intravenous immunoglobulins; M: male; OCP: oral contraceptive pills; PCOS: polycystic ovarian syndrome; SCC: squamous cell carcinoma; SLE: systemic lupus erythematosus; SRA: serotonin release assay; TPO-RA: thrombopoietin receptor agonists, e.g., eltrombopag or romiplostim.