SARS-CoV-2 vaccination and immune thrombotic thrombocytopenic purpura

Shah, Hridaya; Kim, Ann S.; Sukumar, Senthil; Mazepa, Marshall A.; Kohli, Ruhail; Braunstein, Evan M.; Cataland, Spero R.; Chaturvedi, Shruti

doi:10.1182/blood.2022015545

Cited by 11 publications

(20 citation statements)

References 21 publications

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“…Results showed that vaccination does not trigger relapse in these patients, particularly if they are regularly monitored and do not have low ADAMTS13 enzyme activity 12 . Similar results were described by the Vaccine Adverse Event Reporting System (VAERS), the US passive surveillance system for adverse events after immuniziation 13 . COVID-19 vaccine did not increase the risk of de novo or relapsed iTTP, except in individuals in hematologic remission with extremely low ADAMTS13 activity (<20%) [12][13] .…”

Section: To the Editorsupporting

confidence: 75%

“…Giuffrida et al described 5 post-vaccine recurrences among 32 vaccinated patients 14 . The French study showed that COVID-19 vaccination has no causal relationship with iTTP 12 and more recently, the multicenter, retrospective VAERS study confirmed that COVID-19 vaccination does not increase the risk of the novo or relapsed iTTP, particularly if patients are monitored regularly and have normal ADAMTS13 enzyme activity 13 . In this study, the rare iTTP clinical relapses (4/79) occurred only in those patients with low (< 20%) or unknown ADAMTS13 activity levels within 3 months prior to vaccination 13 .…”

Section: To the Editormentioning

confidence: 97%

See 1 more Smart Citation

Covid-19 vaccination in patients with immune-mediated thrombotic thrombocytopenic purpura: a single-referral center experience

et al. 2022

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Section: To the Editorsupporting

confidence: 75%

Section: To the Editormentioning

confidence: 97%

Covid-19 vaccination in patients with immune-mediated thrombotic thrombocytopenic purpura: a single-referral center experience

et al. 2022

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“…Besides VITT, cases of immune thrombocytopenia (ITP) after AstraZeneca (ChAdOx1 nCoV-19) vaccination have been reported, yet antibodies associated with this condition (including anti-PF4 antibodies) have not been identified to date (29,30). Thrombotic thrombocytopenic purpura (TTP), another form of TMA, has also been associated with both mRNA and adenoviral-based COVID-19 vaccination (31,32). In 95% of patients, TTP is caused by the presence of anti-ADAMTS13 autoantibodies, and a decreased (<10%) ADAMTS13 activity is found responsible for the low platelet count.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 vaccination and Atypical hemolytic uremic syndrome

Bouwmeester

Bormans

Duineveld³

et al. 2022

Front. Immunol.

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IntroductionCOVID-19 vaccination has been associated with rare but severe complications characterized by thrombosis and thrombocytopenia.Methods and ResultsHere we present three patients who developed de novo or relapse atypical hemolytic uremic syndrome (aHUS) in native kidneys, a median of 3 days (range 2-15) after mRNA-based (Pfizer/BioNTech’s, BNT162b2) or adenoviral (AstraZeneca, ChAdOx1 nCoV-19) COVID-19 vaccination. All three patients presented with evident hematological signs of TMA and AKI, and other aHUS triggering or explanatory events were absent. After eculizumab treatment, kidney function fully recovered in 2/3 patients. In addition, we describe two patients with dubious aHUS relapse after COVID-19 vaccination. To assess the risks of vaccination, we retrospectively evaluated 29 aHUS patients (n=8 with native kidneys) without complement-inhibitory treatment, who received a total of 73 COVID-19 vaccinations. None developed aHUS relapse after vaccination.ConclusionIn conclusion, aHUS should be included in the differential diagnosis of patients with vaccine-induced thrombocytopenia, especially if co-occuring with mechanical hemolytic anemia (MAHA) and acute kidney injury (AKI). Still, the overall risk is limited and we clearly advise continuation of COVID-19 vaccination in patients with a previous episode of aHUS, yet conditional upon clear patient instruction on how to recognize symptoms of recurrence. At last, we suggest monitoring serum creatinine (sCr), proteinuria, MAHA parameters, and blood pressure days after vaccination.

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“… 16 Nevertheless, two epidemiologic studies clearly suggest that SARS‐CoV‐2 vaccination is unlikely to trigger new‐onset iTTP. 17 , 18 …”

Section: Discussionmentioning

confidence: 99%

“… 16 Nevertheless, two comprehensive epidemiologic studies suggest that SARS‐CoV‐2 vaccination does not increase the risk of first episodes of iTTP, but may induce an acute iTTP bout or a relapse in asymptomatic subjects with a (severely) deficient ADAMTS13 activity. 17 , 18 Patients with an iTTP diagnosis are usually followed up with regular ADAMTS13 activity measurements, and preemptive immunosuppressive treatment is started when ADAMTS13 activity drops to <15%–20% to avert a clinical iTTP relapse. 10 , 11 At many centers, treating physicians have postponed SARS‐CoV‐2 vaccination in iTTP patients when ADAMTS13 activity was <20% and have tried to first correct ADAMTS13 activity levels, often with a course of steroids over 2–4 weeks.…”

Section: Introductionmentioning

confidence: 99%

Hereditary thrombotic thrombocytopenic purpura and COVID‐19: Impacts of vaccination and infection inrare disease

Tarasco

Krogh

Hrdličková

et al. 2022

Research and Practice in Thrombosis and Haemostasis

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Introduction Severe COVID‐19 is associated with an important increase of von Willebrand factor and mild lowering of ADAMTS13 activity that may, in the presence of a strong inflammatory reaction, increase the risk of acute thrombotic thrombocytopenic purpura (TTP). Although acute episodes of immune‐mediated TTP associated with COVID‐19 or SARS‐CoV‐2 vaccination have been reported, data about clinical evolution of hereditary TTP (hTTP) during the pandemic are scarce. Method We conducted a survey among adult patients of the International Hereditary TTP Registry about SARS‐CoV‐2 vaccination, COVID‐19, and occurrence of acute hTTP episodes. Results Of 122 adult hTTP patients invited to participate, 86 (70.5%) responded. Sixty‐five had been vaccinated (75.6%), of which 14 had received in addition a booster, resulting in 139 individual vaccine shots. Although vaccinations in patients on plasma prophylaxis were done within 1 week of the last plasma infusion, all 23 patients treated with plasma on demand were vaccinated without prior plasma infusions. One patient on uninterrupted weekly plasma infusions presented within 3 days from his second vaccination with neurological symptoms and computed tomography scan 9 days later showed subacute ischemic/hemorrhagic frontal lobe infarction. A second male patient developed acute myocarditis after his second dose of mRNA‐1273 vaccine. Twelve (14%) patients had COVID‐19, associated with an acute hTTP episode in three of them: one patient had a transient ischemic attack, one a stroke, and a pregnant woman was hospitalized to intensify plasma treatment. Discussion The risk of an acute episode triggered by COVID‐19 seems higher than following vaccination in hTTP patients, who can be safely vaccinated against SARS‐CoV‐2.

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SARS-CoV-2 vaccination and immune thrombotic thrombocytopenic purpura

Cited by 11 publications

References 21 publications

Covid-19 vaccination in patients with immune-mediated thrombotic thrombocytopenic purpura: a single-referral center experience

Covid-19 vaccination in patients with immune-mediated thrombotic thrombocytopenic purpura: a single-referral center experience

COVID-19 vaccination and Atypical hemolytic uremic syndrome

Hereditary thrombotic thrombocytopenic purpura and COVID‐19: Impacts of vaccination and infection inrare disease

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