COVID-19 Vaccination and Pregnancy: Single Hospital Case Report

Abstract

Reported case has been taken under consideration because of its close relation to the fact of vaccination against COVID-19 (Pfizer BionTech)  first dose.

Multiparous woman at age of 40 years with normal progressive 15 weeks of gestation, has been admitted to the University Clinic on the 10-th day after COVID -19 vaccination with general weakness, joint pain, severe to moderate head ache, fever, at the admission COVID-19 PCR testing occurs to be positive.

Following the protocol of COVID-19 pregnancy management anticoagulant treatment has been started (D-dimer 0.9 mg/dl). The   patient were under observation of infectious disease specialist.  Almost all other protocol based test results within normal ranges, on the 14-th day of vaccination gingival bleeding of moderate severity has been started together with progressive thrombocytopenia (63-10³ m/L later 57-10³ m/L), test of thromb agglutination was positive and the diagnose of idiopathic thrombocytopenia has been announced by hematologist.  Dexamethasone treatment has been initiated with following progressive positive results of thrombocyte count.  On the 12-th day of the admission with normal clinical and laboratory data’s patient has been discharged from the hospital with biweekly follow up for 8 weeks. All follow up laboratory values and clinical data were normal during this period. Based on literature, vaccination induced thrombocytopenia is a rare complication although has been documented and only several of them has proven to be vaccination induced complication. The reported case after assessment of patient’s history, clinical, lab data and VITT adapted scoring system revealed intermediate probability of VITT, coincidence of COVID-19 made difficulties for differentiation of thrombocytopenia reason which needs more accurate laboratory assessment, but unremarkable medical history and short time between vaccination and clinically revealed thrombocytopenia highly suspicious for VITT.