Refractory vaccine-induced immune thrombotic thrombocytopenia (VITT) managed with delayed therapeutic plasma exchange (TPE)


Posted: 2021-10-21 19:00:00
Case Reports J Clin Apher . 2021 Oct 21. doi: 10.1002/jca.21945. Online ahead of print. Affiliations Expand Affiliations 1 Department of Medicine, Section of Hematology/Oncology, The University of Chicago, Chicago, Illinois, USA. 2 Department of Pathology, The University of Chicago, Chicago, Illinois, USA. Item in Clipboard Case Reports Ajay Major et al. J Clin Apher. 2021. Show details Display options Display options Format J Clin Apher . 2021 Oct 21. doi: 10.1002/jca.21945. Online ahead of print. Affiliations 1 Department of Medicine, Section of Hematology/Oncology, The University of Chicago, Chicago, Illinois, USA. 2 Department of Pathology, The University of Chicago, Chicago, Illinois, USA. Item in Clipboard CiteDisplay options Display options Format 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 × 103 /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 Wiley Periodicals LLC. References REFERENCES Scully M, Singh D, Lown R, et al. Pathologic antibodies to platelet factor 4 after ChAdOx1 nCoV-19 vaccination. N Engl J Med. 2021;384(23):2202-2211. doi:10.1056/NEJMoa2105385 Greinacher A, Thiele T, Warkentin TE, Weisser K, Kyrle PA, Eichinger S. Thrombotic thrombocytopenia after ChAdOx1 nCov-19 vaccination. N Engl J Med. 2021;384(22):2092-2101. doi:10.1056/NEJMoa2104840 Schultz NH, Sørvoll IH, Michelsen AE, et al. Thrombosis and thrombocytopenia after ChAdOx1 nCoV-19 vaccination. N Engl J Med. 2021;384(22):2124-2130. doi:10.1056/NEJMoa2104882 Muir K-L, Kallam A, Koepsell SA, Gundabolu K. Thrombotic thrombocytopenia after Ad26.COV2.S vaccination. N Engl J Med. 2021;384(20):1964-1965. doi:10.1056/NEJMc2105869 See I, Su JR, Lale A, et al. US case reports of cerebral venous sinus thrombosis with thrombocytopenia after Ad26.COV2.S vaccination, March 2 to April 21, 2021. JAMA. 2021;325(24):2448. doi:10.1001/jama.2021.7517 Show all 18 references Publication types Case Reports [x] Cite Copy Format: Send To [x]

参考サイト PubMed: covid-19



バイオクイックニュース日本語版:COVID-19特集

バイオクイックニュース日本語版
11月 16, 2020 バイオアソシエイツ

遺伝学とCOVID-19パンデミックに関するの最新の研究結果が発表された【アメリカ人類遺伝学会2020仮想年次総会】

COVID-19 のパンデミックは依然として世界中で猛威を振るっているが、アメリカ人類遺伝学会(ASHG)のメンバーは、ウイルスがどのように広がり、人々に感染するか、感受性と重症度に大きなばらつきがある理由を理解し、そして治療の可能性を探すことに取り組んでいる。10月28日水曜日、6人の研究者がASHG 2020仮想年次総会(10月27-30日)で現在のパンデミックに関連するいくつかの最新の研究結果を発表した。この会議には、世界80か国以上から6,000人を超える登録者が参加した。…

ゲスト 683人 と メンバー 6人 がオンラインです