ChAdOx1 nCov-19 vaccine-induced thrombotic thrombocytopenic purpura successfully treated with plasmapheresis

Wang, Yen-Ching; Chen, Tsung-Chih; Teng, Chieh‐Lin Jerry; Wu, Cheng-Han

doi:10.1007/s00277-021-04701-x

Cited by 9 publications

(10 citation statements)

References 6 publications

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“…In a literature search in PubMed (performed November 28th, 2021; Purpura, Thrombotic Thrombocytopenic; Thrombotic Thrombocytopenic Purpura; ADAMTS-13 Protein; COVID-19 Vaccine; COVID-19 Vaccine Pfizer-BioNTech; Pfizer Covid-19 Vaccine; COVID-19 Vaccine Johnson & Johnson; COVID-19 Vaccine Moderna; COVID-19 Vaccine AstraZeneca; ChAdOx1 COVID-19 Vaccine; Oxford-AstraZeneca COVID-19 Vaccine), we identified 16 reports describing 20 patients with iTTP following COVID-19 vaccination ( 16 – 31 ). Clinical and laboratory characteristics of all previously reported cases and our case are summarized in Table 2 .…”

Section: Immune-mediated Thrombotic Thrombocytopenic Purpura Followin...mentioning

confidence: 99%

“…Exceptions are ticlopidine, but not other members of the thienopyridine family, and drugs with immune-modulatory capacity such as revlimid and checkpoint inhibitors ( 12 – 15 ). More recently, several first episodes, as well as relapses of iTTP have been described following COVID-19 vaccination ( 16 – 31 ). Here we present a new case of de novo iTTP following exposure to the mRNA-based SARS-Cov2-vaccine BNT162b2.…”

Section: Introductionmentioning

confidence: 99%

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Immune-Mediated Thrombotic Thrombocytopenic Purpura Following mRNA-Based COVID-19 Vaccine BNT162b2: Case Report and Mini-Review of the Literature

et al. 2022

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IntroductionAn increasing number of case reports have associated vaccinations against coronavirus disease 2019 (COVID-19) with immune-mediated thrombotic thrombocytopenic purpura (iTTP), a very rare but potentially life-threatening thrombotic microangiopathy, which leads to ischemic organ dysfunction. Thrombus formation in iTTP is related to a severe deficiency of the specific von Willebrand-factor-cleaving protease ADAMTS13 due to ADAMTS13 autoantibodies.MethodsWe present a case of iTTP following exposure to the mRNA-based COVID-19 vaccine BNT162b2 (Comirnaty®, Pfizer-BioNTech). In addition, we review previously reported cases in the literature and assess current evidence.ResultsApart from our case, twenty cases of iTTP occurring after COVID-19 vaccination had been published until the end of November 2021. There were 11 male and 10 female cases; their median age at diagnosis was 50 years (range 14–84 years). Five patients (24%) had a preexisting history of iTTP. Recombinant adenoviral vector-based vaccines were involved in 19%, mRNA-based vaccines in 81%. The median onset of symptoms after vaccination was 12 days (range 5–37), with 20 cases presenting within 30 days. Treatment included therapeutic plasma exchange in all patients. Additional rituximab, caplacizumab, or both these treatments were given in 43% (9/21), 14% (3/21), and 24% (5/21) of cases, respectively. One patient died, despite a prolonged clinical course in one patient, all surviving patients were in clinical remission at the end of the observational period.ConclusionClinical features of iTTP following COVID-19 vaccination were in line with those of pre-pandemic iTTP. When timely initiated, an excellent response to standard treatment was seen in all cases. ADAMTS13 activity should be determined pre-vaccination in patients with a history of a previous iTTP episode. None of the reported cases met the WHO criteria for assessing an adverse event following immunization (AEFI) as a consistent causal association to immunization. Further surveillance of safety data and additional case-based assessment are needed.

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Section: Immune-mediated Thrombotic Thrombocytopenic Purpura Followin...mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Immune-Mediated Thrombotic Thrombocytopenic Purpura Following mRNA-Based COVID-19 Vaccine BNT162b2: Case Report and Mini-Review of the Literature

et al. 2022

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“…This concept is further supported by the expectation that immune cells usually demand more time to mount a response [17] . A second concept raises the possibility of autoantibodies formed against ADAMTS13 after an immunological trigger through mechanisms of molecular mimicry [20] , [29] ( Fig. A ).…”

Section: Discussionmentioning

confidence: 99%

Thrombotic thrombocytopenic purpura (TTP) after COVID-19 vaccination: A systematic review of reported cases

Saluja

Gautam

Yadala

et al. 2022

Thrombosis Research

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“…Although VITT and AIT are more frequently responsible for vaccine-induced thrombocytopenia, TTP has also been observed after COVID-19 vaccination. Most cases have been observed after BNT162b2 (Pfizer-BioNTech) COVID-19 vaccination, 14-17 but some were induced by ChAdOx1 nCov-19 (AstraZeneca) 18 , 19 ( TABLE 3 ) and one case occurred after mRNA-1273 COVID-19 vaccine (Moderna) administration. 20 …”

Section: Discussionmentioning

confidence: 99%

Acquired Thrombotic Thrombocytopenic Purpura After BNT162b2 COVID-19 Vaccine: Case Report and Literature Review

Hammami

Lamarque

Aujoulat

et al. 2022

Laboratory Medicine

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Thrombotic thrombocytopenic purpura (TTP) is a thrombotic microangiopathy that is deadly if not treated promptly. The treatment of choice in patients presenting with TTP is plasma exchanges. However, immunosuppressive therapy and caplacizumab have significantly improved outcomes in TTP. This microangiopathy is classically divided into 2 entities: hereditary and acquired TTP (aTTP), caused by an autoantibody against ADAMTS 13. We present a case study of a patient wth TTP occurring after a second dose of the BNT162b2 (Pfizer-BioNTech) COVID-19 vaccine along with a review of the literature. A 55-year-old patient presented with gastrointestinal symptoms, anemia, and severe thrombocytopenia. The blood film revealed the presence of schistocytes. A diagnosis of aTTP was established because the patient had severe ADAMTS 13 deficiency and autoantibodies against ADAMTS 13 were positive. This episode occurred 10 days after the patient received the COVID-19 vaccine. The patient received plasma exchanges, prednisone, rituximab, and caplacizumab and achieved complete remission. Ten patients with aTTP induced by the COVID-19 vaccine have been reported in the literature. Most of these situations occurred after the second dose of COVID-19 vaccine, and 7 patients were noted to have received the BNT162b2 vaccine. Caplacizumab was used in 6 patients, and complete remission was achieved in 8 patients.

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ChAdOx1 nCov-19 vaccine-induced thrombotic thrombocytopenic purpura successfully treated with plasmapheresis

Cited by 9 publications

References 6 publications

Immune-Mediated Thrombotic Thrombocytopenic Purpura Following mRNA-Based COVID-19 Vaccine BNT162b2: Case Report and Mini-Review of the Literature

Immune-Mediated Thrombotic Thrombocytopenic Purpura Following mRNA-Based COVID-19 Vaccine BNT162b2: Case Report and Mini-Review of the Literature

Thrombotic thrombocytopenic purpura (TTP) after COVID-19 vaccination: A systematic review of reported cases

Acquired Thrombotic Thrombocytopenic Purpura After BNT162b2 COVID-19 Vaccine: Case Report and Literature Review

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