PF4 Immunoassays in Vaccine-Induced Thrombotic Thrombocytopenia

Vayne, Caroline; Rollin, Jérôme; Gruel, Yves; Pouplard, Claire; Galinat, Hubert; Huet, Olivier; Mémier, Vincent; Geeraerts, Thomas; Marlu, Raphaël; Pernod, Gilles; Mourey, Guillaume; Fournel, Alexandra; Cordonnier, Charlotte; Susen, Sophie

doi:10.1056/nejmc2106383

Cited by 94 publications

(78 citation statements)

References 4 publications

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“…In addition to clarifying the binding site of VITT antibodies, these results provide an explanation for why some rapid HIT immunoassays may yield false-negative results for VITT 17 . One rapid HIT immunoassay, the latex immunoturbidimetric assay [HemosIL® HIT-Ab (PF4-H) ] uses KKO to aggregate complexes of PF4/heparin.…”

Section: Binding Site Of Vitt Antibodies On Pf4mentioning

confidence: 93%

Antibody epitopes in vaccine-induced immune thrombotic thrombocytopaenia

Huynh

Kelton

Arnold

et al. 2021

Nature

239

227

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This is a PDF file of a peer-reviewed paper that has been accepted for publication. Although unedited, the content has been subjected to preliminary formatting. Nature is providing this early version of the typeset paper as a service to our authors and readers. The text and figures will undergo copyediting and a proof review before the paper is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers apply.

show abstract

Section: Binding Site Of Vitt Antibodies On Pf4mentioning

confidence: 93%

Antibody epitopes in vaccine-induced immune thrombotic thrombocytopaenia

Huynh

Kelton

Arnold

et al. 2021

Nature

239

227

View full text Add to dashboard Cite

show abstract

“…The results of both rapid and chemiluminescence anti-PF4 assays were negative. Recent report has highlighted the low sensitivity (STic Expert HIT, one out of the 23 reported cases; Acustar, two out of the 49 reported cases) of anti-PF4 rapid immunoassays in cases of suspected VITT, including the Acustar test used in the present case [ 11 , 14 ]. This contrasts with the good performance of this assays reported in “classical” HIT [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…3 ). In addition, presence of anti-PF4 antibodies was confirmed using an enzyme-linked immunosorbent assays (ELISA) with immobilized polyvinyl sulfonate/PF4 complexes (Lifecodes PF4 IgG, Immucor Lifecodes, Jette, Belgium) which has proven to be very sensitive for the detection of anti-PF4 of TTS following SARS-CoV-2 vaccination [ 11 ]. With this test, the optical density (OD) was strongly positive at 2.7 (positivity threshold: 0.4).…”

Section: Case Presentationmentioning

confidence: 99%

Fatal vaccine-induced immune thrombotic thrombocytopenia (VITT) post Ad26.COV2.S: first documented case outside US

et al. 2021

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Purpose We reported the first described post Ad26.COV2.S (Janssen, Johnson & Johnson) vaccine-induced immune thrombocytopenia (VITT) case outside US. Case description CA young woman without any medical history presented association of deep vein thrombosis and thrombocytopenia at day 10 after vaccine injection. The patient was treated with low-molecular weight heparin at a first medical institution. Twelve days post Ad26.COV2.S vaccination, the patient was admitted at our hospital for neurological deterioration and right hemiplegia. Medical imaging using MRI showed thrombosis of the major anterior part of the sagittal superior sinus with bilateral intraparenchymal hemorrhagic complications. Screening tests for antibodies against platelet factor 4 (PF4)–heparin by rapid lateral flow immunoassay and chemiluminescence techniques were negative. Platelet activation test using heparin-induced multiple electrode aggregometry confirmed the initial clinical hypothesis. Despite immediate treatment with intravenous immunoglobulin, dexamethasone, danaparoid and attempted neurosurgery the patient evolved toward brain death. Conclusion Even though it is an extremely rare complication of vaccination physicians should maintain a high index of suspicion of VITT in patients who received an adenovirus-vector-based SARS-CoV-2 vaccine within the last 30 days with persistent complains compatible with VITT or thromboembolic event associated with thrombocytopenia. The diagnosis should not be excluded if the rapid anti-PF4 immunological nor chemiluminescence techniques yield negative results. An adapted functional assay should be performed to confirm the diagnosis. Early treatment with intravenous immunoglobulin and non-heparin anticoagulants is essential as delayed diagnosis and administration of appropriate treatment is associated with poor prognosis.

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“…Current recommendations for VITT lab testing include the use of a sensitive, quantitative, immunologic test and avoiding rapid immunoassays [27]. A PF4/polyanion ELISA is the currently recommended screening test.…”

Section: Hematological Considerationsmentioning

confidence: 99%

Neurosurgical Considerations Regarding Decompressive Craniectomy for Intracerebral Hemorrhage after SARS-CoV-2-Vaccination in Vaccine Induced Thrombotic Thrombocytopenia—VITT

Geßler

Schmitz

Dubinski

et al. 2021

JCM

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Given the ongoing global SARS-CoV-2-vaccination efforts, clinical awareness needs to be raised regarding the possibility of an increased incidence of SARS-CoV-2-vaccine-related immune-mediated thrombocytopenia in patients with intracerebral hemorrhage (ICH) secondary to cerebral sinus and vein thrombosis (CVT) requiring (emergency) neurosurgical treatment in the context of vaccine-induced immune thrombotic thrombocytopenia (VITT). Only recently, an association of vaccinations and cerebral sinus and vein thrombosis has been described. In a number of cases, neurosurgical treatment is warranted for these patients and special considerations are warranted when addressing the perioperative coagulation. We, herein, describe the past management of patients with VITT and established a literature-guided algorithm for the treatment of patients when addressing the impaired coagulation in these patients. Increasing insights addressing the pathophysiology of SARS-CoV-2-vaccine-related immune-mediated thrombocytopenia guide physicians in developing an interdisciplinary algorithm taking into account the special considerations of this disease.

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PF4 Immunoassays in Vaccine-Induced Thrombotic Thrombocytopenia

Cited by 94 publications

References 4 publications

Antibody epitopes in vaccine-induced immune thrombotic thrombocytopaenia

Antibody epitopes in vaccine-induced immune thrombotic thrombocytopaenia

Fatal vaccine-induced immune thrombotic thrombocytopenia (VITT) post Ad26.COV2.S: first documented case outside US

Neurosurgical Considerations Regarding Decompressive Craniectomy for Intracerebral Hemorrhage after SARS-CoV-2-Vaccination in Vaccine Induced Thrombotic Thrombocytopenia—VITT

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