First report of a de novo iTTP episode associated with an mRNA‐based anti‐COVID‐19 vaccination

Abstract

Thrombotic thrombocytopenic purpura (TTP) is a rare but potentially life‐threatening thrombotic microangiopathy (TMA), characterized by disseminated thrombus formation in the microvasculature, causing severe organ failure. Immune‐mediated TTP is occasionally described after vaccination, especially against viral agents. We report a case of a 38‐year old woman with a de novo iTTP after exposure to the mRNA‐based anti‐COVID‐19 vaccine produced by Pfizer‐BioNTech. She presented with increased bruising and petechiae, starting 2 weeks after receiving the first dose of the anti‐COVID‐19 vaccine. Laboratory data revealed a severe ADAMTS13‐deficiency in combination with a very high autoantibody titer against ADAMTS13. She was successfully treated with plasma exchange, corticosteroids, rituximab and Caplacizumab. To our knowledge, this is the first case report of iTTP post mRNA‐based COVID‐19‐vaccination in a previously TTP‐naïve patient.

Cerebral venous thrombosis after COVID-19 vaccination: is the risk of thrombosis increased by intravascular application of the vaccine?

“…For other SARS-CoV-2 vaccines, which do not use adenovirus vectors, similar observations were only reported until now in two women [6,7].…”

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

“…Appropriate vaccination remains the most effective approach against contracting the severe acute respiratory syndrome coronavirus 2 infection and the resulting coronavirus disease 2019 (COVID-19) [ 1 , 2 ]. Although most adverse events due to both adenoviral vector-based (ChAdOx1 nCov-19 and Ad26.COV2.S) and mRNA-based (BNT162b2 mRNA and mRNA-1273) vaccines are tolerable, thrombotic thrombocytopenic purpura (TTP) is a rare but potentially fatal event [ 3 , 4 ]. Herein, we present the case of a patient with ChAdOx1 nCov-19 vaccine-induced TTP successfully treated with plasmapheresis.…”

“…Although cases of TTP after various vaccinations have been previously reported [ 5 ], the pathophysiology of the ChAdOx1 nCov-19 vaccine-induced TTP remains unclear. Autoantibodies against ADAMTS-13 induced by the ChAdOx1 nCov-19 vaccine could be a potential mechanism [ 3 ]. In addition to vaccine-induced immune thrombotic thrombocytopenia [ 6 ], TTP needs to be considered in patients presenting with thrombocytopenia after any COVID-19 vaccination.…”

MEDTEC Students against Coronavirus: Investigating the Role of Hemostatic Genes in the Predisposition to COVID-19 Severity

“…Based on these observations, the vWF/ADAMTS13 imbalance has been proposed to be causally related both to the prothrombotic tendency and to the microvascular pulmonary thrombosis, which subtend to a form of thrombotic microangiopathy (TMA) observed in severe COVID-19 patients. The severe deficiency of ADAMTS13 has also gained attention due to the development of a rare TMA, called immune-mediated thrombotic thrombocytopenic purpura [71,72], caused by the production of anti-ADAMTS13 antibodies, in a limited number of subjects after COVID-19 vaccination. Interestingly, vWF significantly increases with age and in non-0 blood type individuals [73], both risk factors for COVID-19.…”