Introduction:
Immune mediated thrombocytopenia (ITP) is a autoimmune condition characterized by low platelet counts and wide range of clinical manifestations from asymptomatic presentation to major bleeding manifestations. Vaccine mediated secondary ITP is rare and is associated with influenza, measles mumps rubella (MMR), hepatitis A and B vaccination. Most patients respond with steroids and intravenous immunoglobulin.1 We hereby report a case of a 26-year-old female with severe refractory ITP who presented with multiple active bleeding sites leading to a significant drop in hemoglobin post second dose of COVID vaccination. She was refractory to treatment with steroids and intravenous immunoglobulin(IVIG) and was eventually treated with combination of romiplostim and mycophenolate mofetil with which her counts improved dramatically.