tetano
Editor, Senior Moderator
Vox Sang
. 2021 Nov 29.
doi: 10.1111/vox.13227. Online ahead of print.
Influenza-associated thrombotic thrombocytopenic purpura: A report of two cases and a brief review of the literature
Yashvin Onkarappa Mangala[SUP] 1 [/SUP], Joseph D Sweeney[SUP] 2 [/SUP]
Affiliations
Abstract
Background and objectives: Thrombotic thrombocytopenic purpura (TTP) is often preceded by a recent history of an acute infection and influenza is the most implicated virus.
Materials and methods: We identified two cases of TTP, which were preceded by influenza between 2010 and 2021. In one patient, we epitope mapped the binding specificity of antibodies using an overlapping peptide approach of the stalk protein of Influenza B and the cysteine-rich spacer domain (CRSD) of ADAMTS13. A literature search was performed for reports of influenza-associated TTP over the period 1980-2021.
Results: Two patients were identified in which TTP was preceded by influenza, one Influenza A and the other Influenza B. Epitope mapping of the latter's plasma identified target epitopes in both the stalk protein of Influenza B and CRSD of ADAMTS13. The literature review revealed only seven case reports, all but one from Europe or Asia and associated with Influenza A. Severe ADAMTS13 deficiency was demonstrated in only four cases.
Conclusion: We report the first small case series of influenza-associated TTP. Moreover, it is the first case implicating Influenza B and a mechanism favouring polyclonal B-cell proliferation rather than molecular mimicry as the stimulus to form anti-ADAMTS13 auto-antibodies is suggested.
Keywords: ADAMTS13; influenza; thrombotic thrombocytopenic purpura.
. 2021 Nov 29.
doi: 10.1111/vox.13227. Online ahead of print.
Influenza-associated thrombotic thrombocytopenic purpura: A report of two cases and a brief review of the literature
Yashvin Onkarappa Mangala[SUP] 1 [/SUP], Joseph D Sweeney[SUP] 2 [/SUP]
Affiliations
- PMID: 34841536
- DOI: 10.1111/vox.13227
Abstract
Background and objectives: Thrombotic thrombocytopenic purpura (TTP) is often preceded by a recent history of an acute infection and influenza is the most implicated virus.
Materials and methods: We identified two cases of TTP, which were preceded by influenza between 2010 and 2021. In one patient, we epitope mapped the binding specificity of antibodies using an overlapping peptide approach of the stalk protein of Influenza B and the cysteine-rich spacer domain (CRSD) of ADAMTS13. A literature search was performed for reports of influenza-associated TTP over the period 1980-2021.
Results: Two patients were identified in which TTP was preceded by influenza, one Influenza A and the other Influenza B. Epitope mapping of the latter's plasma identified target epitopes in both the stalk protein of Influenza B and CRSD of ADAMTS13. The literature review revealed only seven case reports, all but one from Europe or Asia and associated with Influenza A. Severe ADAMTS13 deficiency was demonstrated in only four cases.
Conclusion: We report the first small case series of influenza-associated TTP. Moreover, it is the first case implicating Influenza B and a mechanism favouring polyclonal B-cell proliferation rather than molecular mimicry as the stimulus to form anti-ADAMTS13 auto-antibodies is suggested.
Keywords: ADAMTS13; influenza; thrombotic thrombocytopenic purpura.