tetano
Editor, Senior Moderator
J Clin Apher
. 2021 Oct 21.
doi: 10.1002/jca.21945. Online ahead of print.
Refractory vaccine-induced immune thrombotic thrombocytopenia (VITT) managed with delayed therapeutic plasma exchange (TPE)
Ajay Major[SUP] 1 [/SUP], Timothy Carll[SUP] 2 [/SUP], Clarence W Chan[SUP] 2 [/SUP], Chancey Christenson[SUP] 2 [/SUP], Fatima Aldarweesh[SUP] 2 [/SUP], Geoffrey D Wool[SUP] 2 [/SUP], Kenneth S Cohen[SUP] 1 [/SUP]
Affiliations
Abstract
Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a newly described hematologic disorder, which presents as acute thrombocytopenia and thrombosis after administration of the ChAdOx1 nCov-19 (AstraZeneca) and Ad26.COV2.S (Johnson & Johnson) adenovirus-based vaccines against COVID-19. Due to positive assays for antibodies against platelet factor 4 (PF4), VITT is managed similarly to autoimmune heparin-induced thrombocytopenia (HIT) with intravenous immunoglobulin (IVIG) and non-heparin anticoagulation. We describe a case of VITT in a 50-year-old man with antecedent alcoholic cirrhosis who presented with platelets of 7 × 10[SUP]3[/SUP] /μL and portal vein thrombosis 21 days following administration of the Ad26.COV2.S COVID-19 vaccine. The patient developed progressive thrombosis and persistent severe thrombocytopenia despite IVIG, rituximab and high-dose steroids and had persistent anti-PF4 antibodies over 30 days after his initial presentation. As such, delayed therapeutic plasma exchange (TPE) was pursued on day 32 of admission as salvage therapy, with a sustained improvement in his platelet count. Our case serves as proof-of-concept of the efficacy of TPE in VITT.
Keywords: coronavirus; platelet factor; thrombocytopenia; thrombosis; vaccines.
. 2021 Oct 21.
doi: 10.1002/jca.21945. Online ahead of print.
Refractory vaccine-induced immune thrombotic thrombocytopenia (VITT) managed with delayed therapeutic plasma exchange (TPE)
Ajay Major[SUP] 1 [/SUP], Timothy Carll[SUP] 2 [/SUP], Clarence W Chan[SUP] 2 [/SUP], Chancey Christenson[SUP] 2 [/SUP], Fatima Aldarweesh[SUP] 2 [/SUP], Geoffrey D Wool[SUP] 2 [/SUP], Kenneth S Cohen[SUP] 1 [/SUP]
Affiliations
- PMID: 34672380
- DOI: 10.1002/jca.21945
Abstract
Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a newly described hematologic disorder, which presents as acute thrombocytopenia and thrombosis after administration of the ChAdOx1 nCov-19 (AstraZeneca) and Ad26.COV2.S (Johnson & Johnson) adenovirus-based vaccines against COVID-19. Due to positive assays for antibodies against platelet factor 4 (PF4), VITT is managed similarly to autoimmune heparin-induced thrombocytopenia (HIT) with intravenous immunoglobulin (IVIG) and non-heparin anticoagulation. We describe a case of VITT in a 50-year-old man with antecedent alcoholic cirrhosis who presented with platelets of 7 × 10[SUP]3[/SUP] /μL and portal vein thrombosis 21 days following administration of the Ad26.COV2.S COVID-19 vaccine. The patient developed progressive thrombosis and persistent severe thrombocytopenia despite IVIG, rituximab and high-dose steroids and had persistent anti-PF4 antibodies over 30 days after his initial presentation. As such, delayed therapeutic plasma exchange (TPE) was pursued on day 32 of admission as salvage therapy, with a sustained improvement in his platelet count. Our case serves as proof-of-concept of the efficacy of TPE in VITT.
Keywords: coronavirus; platelet factor; thrombocytopenia; thrombosis; vaccines.