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Relapse of immune thrombotic thrombocytopenic purpura (iTTP) possibly triggered by COVID-19 vaccination and/or concurrent COVID-19 infection
  1. Fei Fang1,
  2. Brandon Tse2 and
  3. Katerina Pavenski3,4
  1. 1Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  2. 2Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  3. 3Departments of Medicine and Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada
  4. 4Departments of Laboratory Medicine and Medicine, St Michael's Hospital, Toronto, Ontario, Canada
  1. Correspondence to Dr Katerina Pavenski; katerina.pavenski{at}


Thrombotic thrombocytopenic purpura (TTP) is a life-threatening disease that may be triggered by inflammation, including infection or vaccination. Since the start of the COVID-19 pandemic, several case reports were published on de novo or relapsed immune TTP (iTTP) in COVID-19-infected patients. Case reports of iTTP episodes following vaccination against COVID-19 are also emerging. We report a case of relapsed iTTP in a patient who received Moderna mRNA-1273 SARS-CoV-2 vaccine and developed concurrent severe COVID-19 infection. The patient’s iTTP was successfully managed with caplacizumab, therapeutic plasma exchange and high-dose steroids. We summarise published cases of iTTP associated with COVID-19 infection or vaccination.

  • Thrombotic Thrombocytopenic purpura
  • COVID-19
  • Vaccination/immunisation

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  • Contributors FF collected data, conducted literature review and prepared the first draft of the manuscript. BT participated in literature review and writing of the manuscript. KP supervised the project and contributed to writing of the manuscript. All authors have read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests KP participated in industry-sponsored randomised controlled trials and received honoraria for speaking and consulting for Ablynx/Sanofi, Shire/Takeda.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.