Recognizing, managing and reporting vaccine-induced immune thrombotic thrombocytopenia

Sholzberg, Michelle; Arnold, Donald M.

doi:10.1503/cmaj.210882

Cited by 9 publications

(8 citation statements)

References 8 publications

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“…Platelet count below 150 × 10 9 /L [ 82 ], abnormal PT or APTT [ 83 ], significant elevation of D-dimer [ 83 , 84 ], low levels of fibrinogen and positive anti-PF4 antibodies [ [82] , [83] , [84] , [85] ] suggest VITT diagnosis.…”

Section: Resultsmentioning

confidence: 99%

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Acute ischemic stroke and vaccine-induced immune thrombotic thrombocytopenia post COVID-19 vaccination; a systematic review

Kolahchi

Khanmirzaei

Mowla

2022

Journal of the Neurological Sciences

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Section: Resultsmentioning

confidence: 99%

“…Patients who develop arterial or venous thrombosis and thrombocytopenia following receiving the ChAdOx1 nCov-19 vaccine s, should be advised not get a second dose [ 71 , 85 , 90 ].…”

Section: Resultsmentioning

confidence: 99%

Acute ischemic stroke and vaccine-induced immune thrombotic thrombocytopenia post COVID-19 vaccination; a systematic review

Kolahchi

Khanmirzaei

Mowla

2022

Journal of the Neurological Sciences

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“…In VITT, platelet transfusion may worsen the clinical condition, probably because of provision of more PF4, which can form immune complexes with the culprit antibody and result in further activation of platelets. 22 In the largest case series to date from the United Kingdom, platelet transfusion was observed to be associated with progression of thrombosis. In a case series consisting of five VITT patients from Norway, 75% mortality rate was reported of the four patients who received platelet transfusion.…”

Section: Discussionmentioning

confidence: 99%

Thrombocytopenia in the Time of COVID-19

Shweikialrefaee¹,

Hershenfeld²,

Liederman³

2022

Can Journ Gen Int Med

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The COVID-19 infection and associated treatments, including vaccination, can lead to a multitude of hematologic complications. Both vaccine-induced thrombotic thrombocytopenia (VITT) and immune thrombocytopenia (ITP) are possible causes of thrombocytopenia following an adenoviral vector vaccine. While ITP and VITT share many similarities, they have distinct differences and require specialized treatment. Therefore it is critically important to accurately distinguish between these two vaccine-induced disorders. We report a patient who presented with ITP approximately after 1 week of COVID-19 positive diagnosis and 3 weeks after the first dose of AstraZeneca vaccine. RésuméL’infection à la COVID-19 et les traitements qui lui sont associés, dont la vaccination, peuvent entraîner une multitude de complications hématologiques. La thrombocytopénie thrombotique induite par le vaccin (TTIV) et la thrombocytopénie immunitaire (TI) sont deux causes de thrombocytopénie qui peuvent appa-raître après avoir reçu un vaccin à vecteur adénoviral. Bien que la TI et la TTIV présentent de nombreuses similitudes, elles ont des différences marquées et exigent un traitement spécialisé. Il est donc d’une importance cruciale de les distinguer avec exactitude. Dans cet article, nous rapportons le cas d’un patient qui a présenté une TI environ une semaine après avoir reçu un diagnostic de la COVID-19 et trois semaines après avoir reçu une première dose du vaccin d’AstraZeneca.

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“…Other new RNA and DNA vaccines are also used for the first time in a licensed vaccine [4] . COVID-19 vaccine remains critical to control the SARS–CoV–2, the side effects of vaccination including cardiovascular, neurological, gastrointestinal, musculoskeletal, and thromboembolic events have been reported [5] , [6] , [7] , [8] , [9] , [10] . Therefore, early recognition and management for COVID-19 vaccine-associated adverse reactions are imperative.…”

Section: Introductionmentioning

confidence: 99%

The role of anti-platelet factor 4 antibodies and platelet activation tests in patients with vaccine-induced immune thrombotic thrombocytopenia: Brief report on a comparison of the laboratory diagnosis and literature review

Hsiao

Chen

et al. 2022

Clinica Chimica Acta

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Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel human pathogen causing coronavirus disease 2019 (COVID-19). Rare cases of COVID-19 vaccine-induced immune thrombotic thrombocytopenia (VITT) after the ChAdOx1 nCoV-19 (AstraZeneca) vaccination have been reported. We performed a test for anti-heparin/ platelet factor 4 (PF4) antibodies and functional assay using flow cytometry. Method A healthy woman presented to the emergency department with chest pain, headache, and abdominal pain after the first vaccination with AstraZeneca. Polymerase chain reaction (PCR) test for SARS-CoV-2 was negative. Chest computed tomography (CT) showed pulmonary artery embolism and brain magnetic resonance imaging (MRI) revealed cerebral sinus-venous thrombosis. Abdominal CT demonstrated the thrombosis with occlusion in her right hepatic vein. Laboratory studies revealed decreased platelet counts, and high D-dimer level. Finally, laboratory results indicated high PF4 antibodies level high and a positive platelet activation test, confirming the diagnosis of VITT. Results Treatments including intravenous immunoglobulin, methylprednisolone and direct oral anticoagulant were administered. The results of a follow-up platelet count and D-dimer were normal. In addition, the titer of PF4 antibodies (optical density: 0.425; normal ≤ 0.4, enzyme-linked immunosorbent assay) fell. After a 3-month follow-up, her general condition improved gradually. Conclusions The use of COVID-19 vaccines to prevent SARS-CoV-2 infections and complications is considered the most practicable policy for controlling the COVID-19 pandemic and is being forcefully pursued in the global area. Appropriate laboratory diagnosis facilitates the accurate and rapid diagnosis. Early recognizing and appropriate strategies for VITT are required and can provide these patients with more favorable patient outcomes. This report also elected to make comparisons of clinical manifestation, laboratory diagnosis, and management in patients with VITT.

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Recognizing, managing and reporting vaccine-induced immune thrombotic thrombocytopenia

Cited by 9 publications

References 8 publications

Acute ischemic stroke and vaccine-induced immune thrombotic thrombocytopenia post COVID-19 vaccination; a systematic review

Acute ischemic stroke and vaccine-induced immune thrombotic thrombocytopenia post COVID-19 vaccination; a systematic review

Thrombocytopenia in the Time of COVID-19

The role of anti-platelet factor 4 antibodies and platelet activation tests in patients with vaccine-induced immune thrombotic thrombocytopenia: Brief report on a comparison of the laboratory diagnosis and literature review

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