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Indian Pediatr 2016;53: 934-935 |
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Immune Thrombocytopenia Following Diphtheria-Pertussis-
Tetanus and Oral Polio Vaccine
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Arijit Bhowmik and *Tamoghna Biswas
Department of Pediatric Medicine, Medical College
Kolkata, India.
Email: [email protected]
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Post-vaccination immune thrombocytopenia has been reported to occur with
a number of vaccines, of which mumps measles and rubella (MMR) vaccine
appear to be most common. We report a case of immune thrombo-cytopenia
following concurrent immunization with diphtheria-pertussis-tetanus
(DPT) and oral polio (OPV) vaccines.
A 3.5-month-old boy presented with generalized
pupuric rash appearing six days following immunization with third dose
of DPT and OPV. There was no history of any rash after previous doses of
the same vaccines. On examination, there was non-blanching reddish
macular rash over trunk and extremities, but no associated fever,
lymphadenopathy, hepatosplenomegaly, sternal tender-ness or external
bleeding manifestations. Investigations revealed a hemoglobin level of
12.4 g/dL, total leucocyte count 11.3×10 9/L
(neutrophil 52%, lymphocyte 45%, eosinophil 2%), and platelet 8×109/L.
Liver and renal function tests were normal, and tests for anti-nuclear
antibody were negative. Peripheral smear examination revealed no
significant abnormality. Bone marrow examination showed normal
granulocytic and erythro-cytic series, with increased numbers of
megakaryocytes. The child was treated with a single dose of intravenous
immunoglobulin (1g/kg). The rashes gradually disappeared after 3-4 days.
Within 3 days, platelet count increased to 52×109/L
with complete normalization occurring within 7 days. On follow-up,
patient was healthy and booster dose of DPT/ OPV at 18 months of age was
uneventful.
Immune thrombocytopenic purpura (ITP) is generally
rare after immunization. In a study from Canada, 75% of such cases
followed a measles-containing vaccine [1]. DTP or OPV vaccines are less
commonly associated with ITP. Arya, et al. [2] reported
thrombocytopenic purpura following DPT vaccination. In their
retrospective series of 20 cases, Hsieh, et al. [3] also reported
4 cases of ITP after the first dose of diphtheria-tetanus-acellular
pertussis-containing vaccine in early infancy. Other authors [4,5] have
also documented the occurrence of ITP after OPV. In our case, it was not
possible to implicate the individual vaccine causing thrombo-cytopenia
due to concurrent administration of both as per National Immunization
schedule.
References
1. Jadavji T, Scheifele D, Halperin S; Canadian
Paediatric Society/Health Cananda Immunization Monitoring Program.
Thrombocytopenia after immunization of Canadian children, 1992 to 2001.
Pediatr Infect Dis J. 2003;22:119-22.
2. Arya LS, Ghai OP, Saraya AK. Thrombocytopenic
purpura following DPT vaccination. Pediatr Hematol Oncol. 1993;10:381-3.
3. Hsieh YL, Lin LH. Thrombocytopenic purpura
following vaccination in early childhood: experience of a medical center
in the past 2 decades. J Chin Med Assoc. 2010;73:634-7.
4. Jin CQ, Dong HX, Sun ZX, Zhou JW, Dou CY, Lu SH,
et al. Acute immune thrombocytopenic purpura as adverse reaction
to oral polio vaccine (OPV). Hum Vaccin Immunother. 2013;9:1739-40.
5. Akbayram S, Karaman K, Ece Ý, Hatice Akbayram T.
Acute immune thrombocytopenic purpura following oral polio vaccination.
Platelets. 2015;26:705.
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