Prothrombotic immune thrombocytopenia after COVID-19 vaccination
| Autor: | Andreas Tiede, Heiner Wedemeyer, Sonja Werwitzke, Frank Gf Donnerstag, Arnold Ganser, Ulrich J. Sachs, Andreas Czwalinna, Günter U. Höglinger, Benjamin Maasoumy, Joachim K. Krauss, Karin Weißenborn, Rolf Bikker |
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| Rok vydání: | 2021 |
| Předmět: |
0301 basic medicine
Adult Male medicine.medical_specialty Thrombotic microangiopathy •ChAdOx1COVID-19 vaccine (AZD1222 Vaxzevria) COVID-19 Vaccines Immunology •Heparin-induced thrombocytopenia (HIT) •Intravenous immunoglobulin (IVIG) 030204 cardiovascular system & hematology •Anti-platelet factor 4 autoantibodies (anti-FP4) Platelet Factor 4 Biochemistry Gastroenterology Cohort Studies 03 medical and health sciences 0302 clinical medicine Internal medicine ChAdOx1 nCoV-19 medicine Humans Platelet Cerebral venous sinus thrombosis Aged Autoantibodies Purpura Thrombocytopenic Idiopathic business.industry SARS-CoV-2 Brief Report Autoantibody COVID-19 Thrombosis Cell Biology Hematology Heparin Eculizumab Middle Aged medicine.disease •Eculizumab 030104 developmental biology Female business Platelet factor 4 medicine.drug |
| Zdroj: | Blood |
| ISSN: | 1528-0020 |
| Popis: | We report 5 cases of prothrombotic immune thrombocytopenia after exposure to the ChAdOx1 vaccine (AZD1222, Vaxzevria) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Patients presented 5 to 11 days after first vaccination. The spectrum of clinical manifestations included cerebral venous sinus thrombosis, splanchnic vein thrombosis, arterial cerebral thromboembolism, and thrombotic microangiopathy. All patients had thrombocytopenia and markedly elevated D-dimer. Autoantibodies against platelet factor 4 (PF4) were detected in all patients, although they had never been exposed to heparin. Immunoglobulin from patient sera bound to healthy donor platelets in an AZD1222-dependent manner, suppressed by heparin. Aggregation of healthy donor platelets by patient sera was demonstrated in the presence of buffer or AZD1222 and was also suppressed by heparin. Anticoagulation alone or in combination with eculizumab or intravenous immunoglobulin (IVIG) resolved the pathology in 3 patients. Two patients had thromboembolic events despite anticoagulation at a time when platelets were increasing after IVIG. In summary, an unexpected autoimmune prothrombotic disorder is described after vaccination with AZD1222. It is characterized by thrombocytopenia and anti-PF4 antibodies binding to platelets in AZD1222-dependent manner. Initial clinical experience suggests a risk of unusual and severe thromboembolic events. |
| Databáze: | OpenAIRE |
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