Platelet-activating functional assay resolution in vaccine-induced immune thrombotic thrombocytopenia: differential alignment to PF4 ELISA platforms.

Autor: Lee CSM; ANZAC Research Institute, University of Sydney, Sydney, New South Wales, Australia., Clarke LJ; Department of Haematology, Concord Repatriation General Hospital, and NSW Health Pathology, Sydney, New South Wales, Australia.; Australian Red Cross Lifeblood, Sydney, New South Wales, Australia., Kershaw GW; Institute of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia., Tohidi-Esfahani I; ANZAC Research Institute, University of Sydney, Sydney, New South Wales, Australia.; Department of Haematology, Concord Repatriation General Hospital, and NSW Health Pathology, Sydney, New South Wales, Australia., Brighton TA; Department of Haematology, New South Wales Health Pathology, Prince of Wales Hospital, Randwick, Sydney, New South Wales, Australia., Chunilal S; Department of Health Sciences, Monash University, Melbourne, Victoria, Australia., Favaloro EJ; Department of Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), Sydney Centres for Thrombosis and Haemostasis, NSW Health Pathology, Westmead Hospital, Westmead, New South Wales, Australia.; School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Westmead Hospital, Westmead, New South Wales, Australia.; Faculty of Science and Health, Charles Sturt University, Wagga Wagga, New South Wales, Australia., Tran H; Department of Health Sciences, Monash University, Melbourne, Victoria, Australia.; Clinical Haematology Department, The Alfred Hospital, Melbourne, Victoria, Australia.; Australian Centre for Blood Diseases, Monash University, Victoria, Australia., Chen VM; ANZAC Research Institute, University of Sydney, Sydney, New South Wales, Australia.; Department of Haematology, Concord Repatriation General Hospital, and NSW Health Pathology, Sydney, New South Wales, Australia.; Sydney Medical School, University of Sydney, New South Wales, Australia.
Jazyk: angličtina
Zdroj: Research and practice in thrombosis and haemostasis [Res Pract Thromb Haemost] 2023 Mar 25; Vol. 7 (3), pp. 100128. Date of Electronic Publication: 2023 Mar 25 (Print Publication: 2023).
DOI: 10.1016/j.rpth.2023.100128
Abstrakt: Background: Anti-platelet factor 4 (PF4) antibodies in vaccine-induced immune thrombotic thrombocytopenia (VITT) appear to be transient, with discrepant persistence depending on the platform used for detection.
Objectives: We aimed to report a longitudinal study of antibody persistence using 2 ELISA platforms and 2 platelet-activating functional assays in a clinical cohort of patients with VITT referred for follow-up testing.
Methods: In total, 32 Australian patients with VITT or pre-VITT, confirmed by expert adjudication, with samples referred for clinical follow-up were included. Clinical follow-up assays, including Stago and Hyphen ELISAs, procoagulant platelet flow cytometry, and modified PF4-serotonin-release assay, were performed according to the pattern of reactivity for that patient at diagnosis.
Results: The median follow-up was 24 weeks after diagnosis. A general decline in anti-PF4 antibody levels and platelet-activating capacity over time was observed with a more rapid median time to resolution of 16 weeks by functional assay vs 24 weeks by Stago ELISA. Decline in platelet-activating antibody levels detected by functional assays mirrored Stago ELISA titer but not Hyphen. However, 87% of patients received a documented second vaccination and 74% received an mRNA booster with no reported adverse events.
Conclusion: Anti-PF4 antibodies persist longer than functional platelet-activating antibodies in VITT but do not warrant avoidance of subsequent vaccinations. Persistence detection is assay-dependent. Stago ELISA may be a surrogate where functional assays are unavailable for follow-up testing of confirmed patients with VITT.
(© 2023 The Authors.)
Databáze: MEDLINE
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