Thrombocytopenic purpura measles-mumps-rubella

Idiopathic thrombocytopenic purpura, also referred to as immune thrombocytopenic purpura, is a bleeding disorder characterised by destruction of platelets. Antiplatelet autoantibodies are present, suggesting an autoimmune aetiology. These antibodies label the platelets for destruction by macrophages in the spleen. The condition may be acute or chronic. Acute ITP is the most common form and is found most often in children. Some cases are associated with recent viral infections and immunisations, notably the measles, mumps, rubella (MMR) vaccine. Typically, the disease is transient with no evidence of vaccine-associated recurrence. The peak incidence occurs between the ages of... 

Drachtman RA, Murphy S, Ettinger LJ. Exacerbation of chronic idiopathic thrombocytopenic purpura following measles-mumps-rubella immunization. Arch Pediatr Adolesc Med 1994 148(3) 326-7. 

Vlacha V, Forman EN, Miron D, Peter G. Recurrent thrombocytopenic purpura after repeated measles-mumps-rubella vaccination. Pediatrics 1996 97(5) 738-9. 

Hematologic The incidence of immune thrombocytopenic purpura after measles-mumps-rubella (MMR) immunization and the risk of recurrence after repeat immunization have been compared with the incidence after natural measles and rubella in a systematic review [19 ]. On the basis of 12 studies, the incidence of MMR-associated immune thrombocytopenic purpura was 0.087-4 (median 2.6) cases per 100000 vaccine doses. Severe bleeding was rare, and MMR-associated thrombocytopenia resolved within 6 months from diagnosis in 93% of cases. MMR vaccination of unimmunized patients with immune thrombocytopenic purpura and revaccination of patients with prior disease did not lead to recurrence. The authors concluded that MMR-associated immune thrombocytopenic purpura is rare, self-limiting, and non-life-threatening, and that susceptible children with immune thrombocytopenic purpura should be immunized with MMR at the recommended ages. 

Mantadakis E, Farmaki E, Buchanan GR. Thrombocytopenic purpura after measles-mumps-rubella vaccination a systematic review of the literature and guidance for management. J Pediatr 2010 156 623-8. 

France EK, Glanz J, Xu S, Hambidge S, Yamasaki K, Black SB, Marcy M, Mullooly JP, Jackson LA, Nordin J, Belongia EA, Hohman K, Chen RT, Davis R. Risk of immune thrombocytopenic purpura after measles-mumps-rubella immunization in children. Pediatrics 2008 121 e687-92. 

England and Deranark demonstrated that this collaborative approach worked well when they used a common protocol and analysis, and provided individual estimates consistent with the established risk of thrombocytopenic purpura following measles-mumps-rubella (MMR) vaccination [4 ]. 

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Chang SK, Farrell DL, Dougan K, Kobayashi B. Acute idiopathic thrombocytopenic purpura following combined vaccination against measles, mumps, and rubella. J Am Board Fam Pract 1996 9(l) 53-5. 

Autret E, Jonville-Bera AP, Galy-Eyraud C, Hessel L. Purpura thrombopenique apres vaccination isolee on asso-ciee centre la rougeole, la rubeole et les oreillous. [Thrombocytopenic purpura after isolated or combined vaccination against measles, mumps and rubella.] Therapie 1996 51(6) 677-80. 

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