Subject(s)
COVID-19 , Thrombocytopenia , Tissue and Organ Procurement , Vaccines , Ad26COVS1 , Brain Death , Humans , Thrombocytopenia/chemically inducedSubject(s)
COVID-19/prevention & control , ChAdOx1 nCoV-19/adverse effects , Immunoglobulins, Intravenous/therapeutic use , Purpura, Thrombocytopenic, Idiopathic/etiology , Purpura, Thrombocytopenic, Idiopathic/therapy , Adult , Cohort Studies , Female , Humans , Immunoglobulins, Intravenous/administration & dosage , Male , Middle Aged , Platelet Count , Young AdultABSTRACT
The COVID-19 pandemic has resulted in significant morbidity and mortality worldwide. To prevent severe infection, mass COVID-19 vaccination campaigns with several vaccine types are currently underway. We report pathological and immunological findings in 8 patients who developed vaccine-induced immune thrombotic thrombocytopenia (VITT) after administration of SARS-CoV-2 vaccine ChAdOx1 nCoV-19. We analyzed patient material using enzyme immune assays, flow cytometry and heparin-induced platelet aggregation assay and performed autopsies on two fatal cases. Eight patients (5 female, 3 male) with a median age of 41.5 years (range, 24 to 53) were referred to us with suspected thrombotic complications 6 to 20 days after ChAdOx1 nCoV-19 vaccination. All patients had thrombocytopenia at admission. Patients had a median platelet count of 46.5 x109/L (range, 8 to 92). Three had a fatal outcome and 5 were successfully treated. Autopsies showed arterial and venous thromboses in various organs and the occlusion of glomerular capillaries by hyaline thrombi. Sera from VITT patients contain high titer antibodies against platelet factor 4 (PF4) (OD 2.59±0.64). PF4 antibodies in VITT patients induced significant increase in procoagulant markers (P-selectin and phosphatidylserine externalization) compared to healthy volunteers and healthy vaccinated volunteers. The generation of procoagulant platelets was PF4 and heparin dependent. We demonstrate the contribution of antibody-mediated platelet activation in the pathogenesis of VITT.
Subject(s)
COVID-19 , Thrombocytopenia , Adult , Autoantibodies , Blood Platelets , COVID-19 Vaccines , ChAdOx1 nCoV-19 , Female , Humans , Male , Middle Aged , Pandemics , SARS-CoV-2 , Thrombocytopenia/chemically induced , Vaccination/adverse effects , Young AdultABSTRACT
Situations like the COVID-19 pandemic urgently require the implementation of eHealth for vulnerable patient populations. Here we quantitatively evaluate use and potential of modern information and communication technology (ICT) in solid organ transplant (SOT) recipients. We conducted a structured, questionnaire-based, cross-sectional study that was addressed to patients after kidney, liver, pancreas, or combined transplantation. We focused on: sociodemographic data, present use of digital technologies in daily life and for health reasons, patients' eHealth literacy, and their overall attitude towards eHealth. A total of 234 patients completed the questionnaire. Most of the patients (90%) have a web-enabled computer, 78.2% have a smartphone, and 71.8% regularly search the internet for health-related information. Sixty-eight percent would like to receive discharge summaries online, and 54% would like to chat online with their physicians. Even though ICT use in daily life was age-related, no significant difference could be shown for health reasons or the type of transplanted organ. Modern ICT use is predominantly accepted for health reasons by SOT recipients. Regardless of the transplanted organ, a deeper integration of eHealth has potential for improving cross-sectoral care. To successfully implement eHealth technologies in cross-sectoral care future research should include online physician-patient communication, data security, data safety, and the aspects of quality and safety of care.