In the December 2016 issue of the ITP Support Associations quarterly newsletter The Platelet, there were a couple of items about ITP and the flu's jab. Some ITPees say that their platelet counts dropped after the jab, though everyone's experience is different. In response, I thought I'd share my experiences with the flu' vaccine, and viral
infections more generally. This is the gist of what I said, published in the March 2017 issue (pictured right):
At the time of my
ITP diagnosis in summer 2012, I was
already taking immunosuppressants, being 20+ years on from a liver transplant .
As recommended by the transplant team, I’d had the flu' jab annually. After I
had the jab in October 2012, about three
months after my ITP diagnosis , my platelet count
dived from 167 to 12 in a fortnight. I
don't know whether this was the jab, or the change in my immunosuppressants
around the same time(see below), or a combination of both. Either way, this
experience made me very wary of having the flu' jab, and very nervous of
catching infections generally for the next couple of years . With common coughs
and colds, my worries were unfounded –
the usual agro of blocked nose, sore throat etc, but no big drops in my
platelet count.
About six weeks after my ITP diagnosis, I began taking mycophenolate mofetil (MMF), in addition to the immunosuppressants prescribed by the transplant team (
tacrolimus (Prograf) and a 5mg daily maintenance dose of prednisolone). Two
months on from my diagnosis and about
three weeks before my flu’ jab, I was
advised (by a member of the transplant team) to stop the tacrolimus. They
reintroduced this gradually over the next two months, due to renewed liver
problems (rejection) provoked by its withdrawal. I then continued to take MMF
and 5mg prednisolone daily. This combination of immunosuppressants has
kept the liver problems in check
and my platelet count has been stable
for the past four-and-a-half years
(usually 150-165). The main issue has been, unsurprisingly given all my
immunosuppression, lower than normal white blood cell (neutrophil counts),
putting me at increased risk of infection.
After three years of platelet stability I had the jab
in 2015 and 2016 with no problems. After a
particularly vicious, feverish cold
in February 2016 I made my mind up firmly to have the jab from then on.
That cold developed into a chest infection and I generally felt very
unwell. A blood test a few days after this developed (at the
transplant clinic) showed my platelets dropped from 160 to 114. More seriously,
my white cell count was low, my neutrophils only 0.5, putting me at increased
risk of complications from the infection. They advised me to stop my MMF for a
few days and get another blood test done. When I did, it showed my white cells
had returned to normal (neutrophils 2.8). I could then restart my MMF, though
on a lower dose than before (reduced for 1g bd to 500mg bd). Thankfully my
platelet count has held up on this lower MMF dose (and with two more colds
during 2016), though I've still had some lower than normal white cell
(neutrophil) counts.
