Acquired thrombotic thrombocytopenic purpura after first vaccination dose of BNT162b2 mRNA COVID-19 vaccine

Ruhe, Johannes; Schnetzke, Ulf; Kentouche, Karim; Prims, Florian; Baier, Michael; Herfurth, K.; Schlosser, Mandy; Busch, Martin; Hochhaus, Andreas; Wolf, Günter

doi:10.1007/s00277-021-04584-y

Cited by 32 publications

(32 citation statements)

References 10 publications

(16 reference statements)

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“… IVIG, steroids, warfarin Recovered Wiedmann et al [ 59 ] 54 y/o female N/A Numbness of left-sided limbs 6 days post-vaccination, left-sided paralysis and facial nerve palsy. ChAdOx1 nCoV-19 (AstraZeneca) N/A CSVT in nearly all major venous sinuses Methylprednisolone (1 mg/kg) and IVIG (1 g/kg) for 2 days and decompressive hemicraniectomy Death Ruhe et al [ 51 ] 84 y/o Female N/A Partial hemiplegia, scattered petechiae, and severe arterial hypertension. Pfizer-BioNTech mRNA Platelet count = 45 × 10 9 /L Multiple subacute emboli without vessel occlusion.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Vaccine-induced thrombotic thrombocytopenia following coronavirus vaccine: A narrative review

Ahmed

Shaikh

Waseem

et al. 2022

Annals of Medicine &Amp; Surgery

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Section: Introductionmentioning

confidence: 99%

“…Plasma exchange was used in three cases. Two out of the three patients survived [ 50 , 51 ]. Relevant details by Garnier et al were unavailable [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Vaccine-induced thrombotic thrombocytopenia following coronavirus vaccine: A narrative review

Ahmed

Shaikh

Waseem

et al. 2022

Annals of Medicine &Amp; Surgery

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“…For VITT cases, thrombotic thrombocytopenic purpura (TTP) was a differential diagnosis. Several case reports had mentioned the development of TTP after vaccination, including BNT162b2 ( 10 , 11 ), ChAdOx1 ( 12 ), and Ad26.COV2-S ( 13 ). Diagnosis of TTP typically correlates with severely reduced ADAMTS13 activity.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Vaccine-Induced Immune Thrombotic Thrombocytopenia in a Pancreatic Cancer Patient After Vaccination With Messenger RNA−1273

Chen

et al. 2021

Front. Med.

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Vaccination plays an important role during the COVID-19 pandemic. Vaccine-induced thrombotic thrombocytopenia (VITT) is a major adverse effect that could be lethal. For cancer patients, cancer-related thromboembolism is another lethal complication. When cancer patients receive their COVID-19 vaccines, the following thromboembolic events will be more complicated. We presented a case recently diagnosed with pancreatic cancer, who had received the mRNA-1273 (Moderna) vaccination 12 days prior. Ischemic stroke and VITT were also diagnosed. We aggressively treated the patient with steroids, immunoglobulin, and plasma exchange. The titer of anti-platelet factor four and d-dimer level decreased, but the patient ultimately died. The complicated condition of VITT superimposed cancer-related thromboembolism was considered. To our knowledge, only one case of mRNA-1273 related VITT was reported, and this case study was the first to report a cancer patient who was diagnosed with VITT after mRNA-1273 vaccination. Therefore, when the need for vaccination among cancer patients increased under the current COVID-19 pandemic, the possible risk of VITT for cancer patients should be carefully managed. Further studies of the risk evaluation of the COVID-19 vaccine in cancer patients might be required in the future.

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“…All three were isolated from different HDs and originated from the unswitched memory compartment. Altogether, these results indicate that pre-existing anti-SARS-CoV-2 S-reactive B cells may have a high degree of polyreactivity, expansion of these polyreactive MAbs might play a role in thrombotic thrombocytopenia seen in COVID-19 disease and vaccination (Mancini et al 2021;Doevelaar, Bachmann, Hölzer, Seibert, Rohn, Bauer, et al 2021;Ruhe et al 2021;de Bruijn et al 2021).…”

Section: S-reactive B Cells Often Carry a Ighv1-69/igkv3-11-derived Bcr And Are Frequently Polyreactivementioning

confidence: 92%

A public antibody class recognizes a novel S2 epitope exposed on open conformations of SARS-CoV-2 spike

Claireaux

Caniels

Gast

et al. 2021

Preprint

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Delineating the origins and properties of antibodies elicited by SARS-CoV-2 infection and vaccination is critical for understanding their benefits and potential shortcomings. Therefore, we investigated the SARS-CoV-2 spike (S)-reactive B cell repertoire in unexposed individuals by flow cytometry and single-cell sequencing. We found that ∼82% of SARS-CoV-2 S-reactive B cells show a naive phenotype, which represents an unusually high fraction of total human naive B cells (∼0.1%). Approximately 10% of these naive S-reactive B cells shared an IGHV1-69/IGKV3-11 B cell receptor pairing, an enrichment of 18-fold compared to the complete naive repertoire. A proportion of memory B cells, comprising switched (∼0.05%) and unswitched B cells (∼0.04%), was also reactive with S and some of these cells were reactive with ADAMTS13, which is associated with thrombotic thrombocytopenia. Following SARS-CoV-2 infection, we report an average 37-fold enrichment of IGHV1-69/IGKV3-11 B cell receptor pairing in the S-reactive memory B cells compared to the unselected memory repertoire. This class of B cells targets a previously undefined non-neutralizing epitope on the S2 subunit that becomes exposed on S proteins used in approved vaccines when they transition away from the native pre-fusion state because of instability. These findings can help guide the improvement of SARS-CoV-2 vaccines.

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Acquired thrombotic thrombocytopenic purpura after first vaccination dose of BNT162b2 mRNA COVID-19 vaccine

Cited by 32 publications

References 10 publications

Vaccine-induced thrombotic thrombocytopenia following coronavirus vaccine: A narrative review

Vaccine-induced thrombotic thrombocytopenia following coronavirus vaccine: A narrative review

Case Report: Vaccine-Induced Immune Thrombotic Thrombocytopenia in a Pancreatic Cancer Patient After Vaccination With Messenger RNA−1273

A public antibody class recognizes a novel S2 epitope exposed on open conformations of SARS-CoV-2 spike

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