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1.
Bmj Case Reports ; 15(8), 2022.
Article in English | Web of Science | ID: covidwho-2019952

ABSTRACT

A male in his teens with a history of liver transplant for biliary atresia (aged 2 years) and autoimmune haemolytic anaemia (AIHA, aged 6 years) presented with jaundice, dark urine, fatigue and chest discomfort that began 48 hours after the first dose of SARS-CoV-2 Pfizer-BioNTech vaccine (BNT162b2 mRNA). Investigations revealed a warm AIHA picture. Over 4 weeks the patient developed life-threatening anaemia culminating in haemoglobin of 35 g/L (after transfusion), lactate dehydrogenase of 1293 units/L and bilirubin of 228 mu mol/L, refractory to standard treatment with corticosteroids and rituximab. An emergency splenectomy was performed that slowed haemolysis but did not completely ameliorate it. Eculizumab, a terminal complement pathway inhibitor, was initiated to arrest intravascular haemolysis and showed a favourable response. AIHA is rare but described after the SARS-CoV-2 Pfizer-BioNTech vaccine. This case highlights the rare complication of AIHA, the use of emergency splenectomy for disease control, and the use of eculizumab.

2.
BMJ Case Reports ; 15(9), 2022.
Article in English | ProQuest Central | ID: covidwho-2019951

ABSTRACT

Multicentric Castleman disease (MCD) is a rare lymphoproliferative disorder typically manifesting with bulky lymphadenopathy in multiple lymph node stations. We describe an atypical presentation of human herpes virus 8 (HHV8)-associated MCD in a middle-aged man with no significant medical history who presented with 1 month of systemic symptoms. He was found to be HIV-1 positive. A physical examination did not reveal palpable lymphadenopathy. A contrast-enhanced CT scan was notable for hepatosplenomegaly and mildly enlarged scattered lymph nodes in the abdomen and pelvis. A positron emission tomography/CT scan demonstrated hypermetabolic cervical chain lymph nodes. Posterior cervical lymph node pathology showed HHV8-positive MCD with concurrent HIV-associated Kaposi sarcoma. The patient was treated with rituximab and liposomal doxorubicin without response. We emphasise the lack of the hallmark of bulky lymphadenopathy in this patient, and the importance of a timely pathological diagnosis in MCD.

3.
Bmj Case Reports ; 15(9), 2022.
Article in English | Web of Science | ID: covidwho-2019948

ABSTRACT

Immune thrombocytopaenic purpura (ITP) is often a diagnosis of exclusion with presentations ranging widely from asymptomatic patients to those with life-threatening bleeding. Secondary ITP following vaccination is relatively uncommon and underdiagnosed as majority of patients remain asymptomatic. Cases of severe thrombocytopaenia associated with SARS-CoV-2 messenger RNA (ribonucleic acid) vaccinations have been described previously, mostly as isolated occurrences, and typically occurring following the first dose. Here we present a case of severe ITP associated with the second dose of the Pfizer-BioNTech/BNT16B2b2 mRNA vaccine and provide a review of the current literature.

4.
Journal of Mahanakorn Veterinary Medicine ; 17(1):123-133, 2022.
Article in Thaï | CAB Abstracts | ID: covidwho-2012234

ABSTRACT

A male Munchkin cat was brought to a small animal teaching hospital at Mahanakorn University of Technology. The patient presentation with vomiting, chronic diarrhea, and intermittent fever. From history-taking, the owner previously had a cat that was diagnosed with feline infectious peritonitis (FIP) living in the same house but had isolated in a separate area. Fecal examination revealed bacterial enteritis. Hematology and blood chemistry results shown lymphopenia, hypoalbuminemia, and low serum albumin/globulin ratio (0.3 A: G ratio). Abdominal ultrasound revealed mesenteric lymph node (MLN) enlargement and cholecystitis. Cell cytology from the liver and MLN revealed suppurative inflammation. Reverse transcription PCR (RT-PCR) was negative for the Feline coronavirus (FCoV) in the blood sample. On the 4th day of treatment, the cat developed pleural and peritoneal effusion. Thoracentesis and abdominocentesis were performed and submitted for analysis. The fluid's results were classified as modified transudate, low A: G ratio (0.3), Rivalta's test (positive), and positive for FCoV by using RT-PCR. On the 8th day of treatment, the cat died from systemic hypotension. Viscous straw yellow-colored fluid and pyogranulomatous lesions at the liver, lung, kidney, and MLN were observed from the necropsy. Histopathology's results shown severe suppurative inflammation in all the above organs. FIP was confirmed by detected FCoV antigen in the cytoplasm of macrophages in the kidney and lung tissue by immunohistochemistry staining.

5.
Indonesia Medicus Veterinus ; 11(3):412-423, 2022.
Article in Indonesian | CAB Abstracts | ID: covidwho-1994709

ABSTRACT

Minmin, a 1-year-old male local cat weighing 4.3 kg has decreased appetite and an enlarged abdominal cavity. Based on physical examination, there was abdominal distension. Routine hematology and blood biochemical examinations were performed which showed chronic inflammation and abnormal liver and kidney function. Radiographic examination and abdominocentesis showed fluid accumulation in the abdominal cavity (ascites) with pale yellow fluid and thickened liquid consistency. The results of the rivalta test showed a positive accumulation of exudate which was characterized by a jellyfish-like formation. The cat was diagnosed with effusive feline infectious peritonitis. The therapies given are diuretic furosemide 5 mg/kg BW (twice a day) intravenously, antibiotic cefotaxime sodium 30 mg/kg BW (twice a day) intravenously, anti-inflammatory dexamethasone 0,5 mg/kg BW (twice a day) subcutaneously, hepato-protector betaine 2.5 mg/kg BW (every two days) subcutaneously, and keto acid 11 mg/kg BW orally (every two days). The results of treatment for one week only provide temporary results in reducing the degree of abdominal distension. The cat died in the sixth month after therapy.

6.
Trials ; 23(1): 509, 2022 Jun 18.
Article in English | MEDLINE | ID: covidwho-1962885

ABSTRACT

BACKGROUND: Understanding patient and health practitioner perspectives on clinical trials can inform opportunities to enhance trial conduct and design, and therefore patient experience. Patients with haematological cancers have faced additional risk and uncertainty during the pandemic but it is unclear how they and practitioners have experienced cancer trials during this period. In the context of a haemato-oncology trial (PETReA), we compared patient and practitioner views and experiences of PETReA before and during COVID-19. METHODS: Qualitative study embedded within PETReA. Semi-structured interviews (N=41) with patients and practitioners from 16 NHS sites before (n=17) and during the first wave of COVID-19 (n=24). Analysis drew on the framework approach. RESULTS: Practitioners acknowledged the need for the trial to continue during the pandemic but their treatment preferences altered, becoming more pronounced for patients who had a favourable response to induction treatment, while staying unchanged for patients with a less favourable response. Practitioners commented that COVID-19 meant the evidence base for the trial arms was lacking or mixed, but that it likely increased the risks of maintenance treatment for patients with a favourable response to induction treatment. While only one participant interviewed withdrew from PETReA during the pandemic, others said they would consider withdrawing if information that they were at increased risk of severe illness from COVID-19 became available. During COVID-19, patients described less frequent contact with the trial team, which left some feeling less clear about their trial pathway. However, several described having in-depth, collaborative discussions with practitioners about the risks and benefits of randomisation in the context of COVID-19. Patients valued these discussions and were reassured by the emphasis practitioners placed on patients being free to withdraw if circumstances changed, and this helped patients feel comfortable about continuing in PETReA. CONCLUSIONS: The findings point to ways trial communication can support patients to feel comfortable about continuing in a trial during uncertain times, including adopting a more in-depth, collaborative exploration of the risks and benefits of trial arms with patients and emphasising voluntariness. The results are relevant to trialists recruiting patients who are clinically extremely vulnerable or are at increased risk of poor COVID-19 outcomes despite being vaccinated.


Subject(s)
COVID-19 , Neoplasms , Clinical Trials as Topic , Communication , Humans , Neoplasms/therapy , Pandemics/prevention & control , Qualitative Research
7.
BMJ Open ; 12(7): e059944, 2022 07 18.
Article in English | MEDLINE | ID: covidwho-1950183

ABSTRACT

OBJECTIVE: To compare outcomes between O and non-O blood groups, and by modified RNA (mRNA) and adenovirus-vectored (Ad-V) vaccines. DESIGN: Population-based cohort study. SETTING: All of Ontario, Canada. Linked data sets captured clinical encounters, vaccinations and laboratory testing for SARS-CoV-2. PARTICIPANTS: Individuals aged 12+ years with known ABO blood group and free of SARS-CoV-2 before 15 January 2021. MAIN OUTCOMES MEASURES: The main exposure, first SARS-CoV-2 vaccination, was modelled in a time-varying manner. O and non-O blood group was known prior to vaccination. SARS-CoV-2 infection, and severe COVID-19 (hospitalisation or death), were assessed starting 14 days after vaccination, up to 27 June 2021. RESULTS: 2 472 261 individuals were included. 1 743 916 (70.5%) had at least one vaccination, of which 24.6% were fully vaccinated. Those vaccinated were more likely to be women, older in age, residing in a higher-income area and have higher rates of certain comorbid conditions, like cancer, diabetes and hypertension. Relative to unvaccinated, after receiving their first mRNA (adjusted HR (aHR) 0.46, 95% CI 0.44 to 0.47) or Ad-V (aHR 0.49, 95% CI 0.44 to 0.54) vaccine, the risk of SARS-CoV-2 infection was lower, as was severe COVID-19 (aHR 0.29, 95% CI 0.20 to 0.43 (mRNA); aHR 0.29, 95% CI 0.26 to 0.33 (Ad-V)). Stratifying by blood group produced similar results. For example, after first mRNA vaccination, the aHR of severe COVID-19 was 0.31 (95% CI 0.27 to 0.36) among non-O blood groups, and 0.27 (95% CI 0.22 to 0.32) among O blood groups, relative to unvaccinated. Fully vaccinated individuals had the lowest risk of SARS-CoV-2 and severe COVID-19. CONCLUSIONS: SARS-CoV-2 infection and severe COVID-19 are reduced by vaccination. This effect does not vary by vaccine type or blood group, but is more pronounced among fully, than partially, vaccinated individuals.


Subject(s)
COVID-19 , Viral Vaccines , ABO Blood-Group System , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines , Cohort Studies , Female , Humans , Male , Ontario/epidemiology , RNA, Messenger , SARS-CoV-2 , Vaccination
8.
Studies in Big Data ; 109:293-314, 2022.
Article in English | Scopus | ID: covidwho-1941432

ABSTRACT

In recent development of machine learning (ML)-based medical image analysis that have contributed to the prediction, planning, and early diagnostic process. Different chronic hermitic diseases like blood cancer/leukemia, AIDs, malaria, anemia and even COVID-19, all these are diagnoses via analyzing leucocytes or white blood cells (WBCs). Leucocytes analysis is the process of detection, localization, counting, analyzing WBCs, and it perform an active role in clinical hematology to assist health specialists in early stage disease diagnosing process. An automatic leucocytes analysis provide valuable diagnostics facts to doctors, via they can automatically detect, blood cancer, brain tumor and significantly improve the hematological, pathological activities. Manual Detection, counting and classification of WBCs is very slow, challenging and boring task due to having complex overlapping and morphological uneven structure. In this chapter, we provide a concise analysis of available ML techniques, to use these techniques for leucocytes analysis in microscopic images. The main aim of this chapter is to identify high performer and suitable ML algorithms for WBCs analysis using blood microscopic smear images. In the proposed review study, the recent and most relevant research papers are collected from IEEE, Science Direct, springer, and web of science (WoS) with the following keywords: ‘leucocytes detection’ or ‘leucocytes classification’. This study gives an extensive review of MIA but the research focuses more on the ML-based leucocytes/WBCs analysis in smear images. These techniques include traditional machine learning (TML), deep learning (DL), convolutional neural network (CNN) models, hybrid learning, and attention learning-based techniques to analyze medical image modalities to detect and classify cells in smear images. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

9.
Clin Med (Lond) ; 22(3): 214-217, 2022 05.
Article in English | MEDLINE | ID: covidwho-1903881

ABSTRACT

New thrombocytopenia may be associated with a variety of conditions and diagnosis can be challenging. Presentation can vary from life-threatening bleeding or thrombosis to an incidental finding in an asymptomatic patient. New thrombocytopenia requires urgent investigation. Investigations are mainly guided by findings from the clinical history, physical examination, full blood count and blood film analysis. Aside from the actively bleeding patient, rare but life-threatening causes of thrombocytopenia must be identified early as they require urgent treatment. These include thrombotic thrombocytopenic purpura, disseminated intravascular coagulation, suspicion of new acute promyelocytic leukaemia, and vaccine-induced prothrombotic immune thrombocytopenia. Here, we discuss how to approach a patient with new thrombocytopenia, along with key differentials not to be missed.


Subject(s)
Disseminated Intravascular Coagulation , Purpura, Thrombotic Thrombocytopenic , Blood Cell Count , Disseminated Intravascular Coagulation/complications , Disseminated Intravascular Coagulation/etiology , Hemorrhage , Humans , Purpura, Thrombotic Thrombocytopenic/complications , Purpura, Thrombotic Thrombocytopenic/diagnosis , Purpura, Thrombotic Thrombocytopenic/therapy
10.
BMJ Case Rep ; 15(6)2022 Jun 20.
Article in English | MEDLINE | ID: covidwho-1901951

ABSTRACT

Immune thrombocytopenic purpura (ITP) is an autoimmune disorder caused by autoantibodies against platelet antigens resulting in platelet destruction and inhibition of platelet production. Occasionally, an inciting event such as a virus or vaccination can precipitate ITP. Several cases of ITP have been reported after the BTN162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) SARS-CoV-2 (COVID-19) vaccines. All reported cases of post-vaccination ITP have resolved with medical therapy until this case.A man in his mid-20s developed bleeding from ITP 2 weeks after receiving the second dose of the Pfizer SARS-CoV-2 vaccine. All inpatient medical treatment attempts failed. On hospital day 40, a splenectomy was performed and he ultimately recovered and was discharged.Awareness of potential vaccination side effects is a fundamental element of refining and improving patient safety. This case illustrates that given the right circumstances, serious refractory ITP can develop in response to the second dose of the Pfizer SARS-CoV-2 vaccine.


Subject(s)
BNT162 Vaccine , COVID-19 , Purpura, Thrombocytopenic, Idiopathic , Splenectomy , BNT162 Vaccine/adverse effects , Humans , Male , Purpura, Thrombocytopenic, Idiopathic/chemically induced , Purpura, Thrombocytopenic, Idiopathic/surgery , SARS-CoV-2
11.
BMJ Case Rep ; 15(6)2022 Jun 10.
Article in English | MEDLINE | ID: covidwho-1891769

ABSTRACT

A man in his late 50s presented with unilateral pain and discolouration of his fourth and fifth toes suggestive of digital ischaemia. He had a medical history of two unprovoked venous thromboembolisms in the preceding 18 months and a history of monoclonal gammopathy of undetermined significance (MGUS). A CT scan showed evidence of large vessels vasculitis in the absence of circulating antineutrophil cytoplasmic antibodies. Biopsy of the toes showed evidence of light chain and immunoglobulin deposition on immunofluorescence suggesting vasculitis secondary to his haematological diagnosis of MGUS. The patient was treated with high dose glucocorticoids and immunosuppressive treatment with a significant improvement in his symptoms and features of digital ischaemia.


Subject(s)
Monoclonal Gammopathy of Undetermined Significance , Vasculitis , Antibodies, Antineutrophil Cytoplasmic , Glucocorticoids/therapeutic use , Humans , Ischemia/drug therapy , Male , Monoclonal Gammopathy of Undetermined Significance/complications , Monoclonal Gammopathy of Undetermined Significance/diagnosis , Vasculitis/diagnosis , Vasculitis/drug therapy , Vasculitis/etiology
12.
Bulgarskii Meditsinski Zhurnal / Bulgarian Medical Journal ; 16(1):42-49, 2022.
Article in Bulgarian | GIM | ID: covidwho-1888259

ABSTRACT

For the treatment of coronavirus disease 2019 (COVID-19), health systems have developed disease management strategies. The use of convalescent plasma in patients with severe acute respiratory syndrome (Sars-Cov-2) is recommended. The use of plasma from a donor who has survived COVID-19 is potentially expected to have a good effect.

13.
Journal of Cardiovascular Disease Research ; 13(2):747-752, 2022.
Article in English | GIM | ID: covidwho-1864126

ABSTRACT

Background: Covid 19 is a newly emergent contagious infectious disease caused by severe acute respiratory syndrome (SARS) - Cov-2 virus that was not found previously in human which belongs to a large family of corona virus. The severity of the disease is altered by alteration of biochemical parameters. This study aims to evaluate somehematological and biochemical parameters in Covid 19 patients admitted at dedicated Covid 19 hospital. To determines hematological and biochemical parameters in Covid 19 patients. Material and Methods: Present study comprised of 70 Covid 19 patients who admitted at dedicated Covid 19 ward during second wave. They include 22 female and 48 male subjects aged between 15 - 75 years. The data was entered in MS EXCEL spreadsheet and analysis was done using Statistical Package for Social Sciences (SPSS) version 25.0.

14.
BMJ Open ; 12(5): e054787, 2022 05 04.
Article in English | MEDLINE | ID: covidwho-1854339

ABSTRACT

OBJECTIVE: The ACROBAT pilot trial of early cryoprecipitate for severe postpartum haemorrhage used deferred consent procedures. Pretrial discussions with a patient and public involvement group found mixed views towards deferred consent. This study aimed to build an understanding of how the deferred consent procedures worked in practice, to inform plans for a full-scale trial. SETTING: Qualitative interview study within a cluster-randomised pilot trial, involving four London maternity services. PARTICIPANTS: Individual interviews were conducted postnatally with 10 women who had received blood transfusion for severe postpartum haemorrhage and had consented to the trial. We also interviewed four 'recruiters'-two research midwives and two clinical trials practitioners who conducted trial recruitment. RESULTS: Consent procedures in the ACROBAT pilot trial were generally acceptable and the intervention was viewed as low risk, but most women did not remember much about the consent conversation. As per trial protocol, recruiters sought to consent women before hospital discharge, but this time pressure had to be balanced against the need to ensure women were not approached when distressed or very unwell. Extra efforts had to be made to communicate trial information to women due to the exhaustion of their recovery and competing demands for their attention. Participant information was further complicated by explanations about the cluster design and change in transfusion process, even though the consent sought was for access to medical data. CONCLUSION: Our findings indicate that deferred consent procedures raise similar concerns as taking consent when emergency obstetric research is occurring-that is, the risk that participants may conflate research with clinical care, and that their ability to process trial information may be impacted by the stressful nature of recovery and newborn care. A future trial may support more meaningful informed consent by extending the window of consent discussion and ensuring trial information is minimal and easy to understand. TRIAL REGISTRATION NUMBER: ISRCTN12146519.


Subject(s)
Postpartum Hemorrhage , Female , Humans , Infant, Newborn , Informed Consent , Male , Pilot Projects , Postpartum Hemorrhage/therapy , Postpartum Period , Pregnancy , Qualitative Research
15.
BMJ Case Rep ; 15(5)2022 May 18.
Article in English | MEDLINE | ID: covidwho-1854261

ABSTRACT

Superwarfarin (long-acting anticoagulant rodenticide) poisoning should be suspected in unexplained bleeding with prolonged prothrombin time, especially in the absence of another explanation. Diagnosis and treatment of this intoxication remain a challenge as the direct analysis of superwarfarin in serum is not always possible. Therefore, toxin bioavailability remains unknown and close monitoring and treatment for long periods are required to avoid serious bleeding complications. Here, we discuss a case of suspected superwarfarin poisoning to highlight the challenges in early diagnosis and the challenges we encountered in treatment management and ensuring compliance for long periods.


Subject(s)
4-Hydroxycoumarins , Blood Coagulation Disorders , Poisoning , Rodenticides , Anticoagulants , Blood Coagulation Disorders/chemically induced , Humans , Poisoning/therapy
16.
BMJ Case Rep ; 15(5)2022 May 11.
Article in English | MEDLINE | ID: covidwho-1840565

ABSTRACT

Since the start of vaccination against COVID-19 viral infection using adenovirus-based vector vaccine (eg, The Oxford-AstraZeneca vaccine, using the modified chimpanzee adenovirus ChAdOx1, and the Johnson & Johnson vaccine, using human adenovirus serotype 26), a rare, but potentially life-threatening complication called vaccine-induced thrombotic thrombocytopenia (VITT) was reported. As the number of cases increases every day, with the increase in the number of vaccinated people all over the world, this complication is a concern to the medical field. We report a case on the acute management of a patient who presented to us with life-threatening bilateral pulmonary embolism as a complication of VITT after the first dose of vaccination with Oxford-AstraZeneca vaccine against COVID-19.


Subject(s)
COVID-19 , Pulmonary Embolism , Thrombocytopenia , Thrombosis , Vaccines , COVID-19 Vaccines/adverse effects , ChAdOx1 nCoV-19 , Humans , Pulmonary Embolism/complications , Pulmonary Embolism/etiology , SARS-CoV-2 , Thrombocytopenia/chemically induced , Thrombosis/complications , Vaccination/adverse effects , Vaccines/adverse effects
17.
Texila International Journal of Public Health ; 9(3), 2021.
Article in English | GIM | ID: covidwho-1841769

ABSTRACT

The patho-physiology of COVID19 is still not clear. This study investigated the status of coagulation, LDH activity, and inflammation in SARS-CoV-2 infected patients. One hundred and thirty-four newly diagnosed COVID19 infected patients (age ranged 65-82 years) attending Mullingar Regional Hospital, Mullingar, Republic of Ireland, volunteered to participate in this study. They all presented with a pulmonary disorder, pyrexia, vomiting, body pains, etc. SARS-CoV-2 confirmatory test was done with RT-PCR molecular test using Cepheid Genexpert System. The data of another 121 plasma samples of apparently normal, non-COVID19 infected individuals taken before the emergence of COVID19 served as controls. Levels of blood platelets was determined in the participants using Siemen ADVIA 2120 Haematological System, and plasma D-dimer was determined in the participants using Star Max-Stago-Automatic Coagulation Analyzer LDH activity, plasma ferritin, and C-reactive protein (CRP) were determined in the participants using Beckman AU680-Chemistry Analyser. SARS-CoV-2 -infected patients showed significantly (p< 0.001) higher levels of D-dimer (1522.95+1395.45 ng/ml), CRP (125.3+116.4 mg/l), ferritin (488.5+514.9pg/l), and LDH activity (574.4+446.7iu/l) compared to controls (78.8+18.1 ng/ml, 2.4+1.7 mg/l, 61.3+58.2pg/l, 304.1+76.6iu/l respectively). The blood platelet count did not show significant (p>0.05) change in the COVID19 patients (252.2 x 109+101 x 109) compared to controls (256.4 x 109+63.2 x 109). Elevated LDH activity could indicate tissue breakdown in the SARS-Cov-2 infected patients. Hyper-coagulation and inflammation are imminent in the COVID19 patients. Adjuvant anticoagulant and anti-inflammatory therapies may be useful as part of therapeutic regimen in the SARS-CoV-2 infected patients.

18.
BMJ Case Rep ; 15(4)2022 Apr 29.
Article in English | MEDLINE | ID: covidwho-1832378

ABSTRACT

Impaired immune response with uncontrolled inflammation and various immunological disorders have been reported during SARS-CoV-2 infection. Here, we report a case of cold agglutinin disease occurring during a severe coronavirus disease 2019 (COVID-19) in a French intensive care unit. A patient was presented with acute respiratory distress syndrome, acute renal failure and haemolytic anaemia. Direct antiglobulin test was positive with a cold agglutinin titre of 1/512. No other cause than COVID-19 explained the occurrence of cold agglutinin disease; however, causality could not be formally established. Persistent anaemia despite transfusion therapy and the short-term life-threatening, prompted the infusion of a monoclonal anti-C5 antibody (eculizumab). Eculizumab therapy quasi-fully resolved haemolysis within a few days, but ultimately the patient died from his severe COVID-19 infection. Data regarding the specific treatment of cold agglutinin disease during COVID-19 are rare. Although additional studies are warranted, eculizumab may be considered in critical situations.


Subject(s)
Anemia, Hemolytic, Autoimmune , COVID-19 , Anemia, Hemolytic, Autoimmune/drug therapy , Anemia, Hemolytic, Autoimmune/etiology , Antibodies, Monoclonal, Humanized/therapeutic use , COVID-19/complications , Humans , SARS-CoV-2
19.
BMJ Case Rep ; 15(4)2022 Apr 06.
Article in English | MEDLINE | ID: covidwho-1779331

ABSTRACT

A 49-year-old woman presented with severe abdominal pain and per rectal bleed, 13 days after receiving the first dose of the AstraZeneca vaccine. Blood tests showed remarkably low platelet count, unmeasurable D-dimer levels and low fibrinogen levels, consistent with a diagnosis of vaccine-induced thrombotic thrombocytopaenia and disseminated intravascular coagulation. CT mesenteric angiogram revealed massive portosplenic mesenteric vein thrombosis. CT head also noted non-occlusive thrombosis at several sites. She was treated with intravenous immunoglobulins, plasma exchange, anticoagulants and transjugular intrahepatic portosystemic shunt procedure. Following a prolonged inpatient stay, she was discharged with subsequent short bowel syndrome and long-term parenteral nutrition. This particular clinical scenario aims to highlight the importance for clinicians to remain vigilant for rare complications associated with the AstraZeneca vaccine and the subsequent management involved, at a time where it is vital to vaccinate globally in order to control the spread of the COVID-19 pandemic.


Subject(s)
COVID-19 , Thrombocytopenia , Thrombosis , Vaccines , Venous Thrombosis , COVID-19 Vaccines/adverse effects , Edema , Female , Humans , Ischemia , Middle Aged , Pandemics , SARS-CoV-2 , Thrombocytopenia/chemically induced , Thrombocytopenia/diagnosis , Vaccines/adverse effects , Venous Thrombosis/etiology
20.
BMJ Case Rep ; 15(3)2022 Mar 24.
Article in English | MEDLINE | ID: covidwho-1765101

ABSTRACT

Thrombotic thrombocytopenic purpura (TTP) is a type of thrombotic microangiopathy that is characterized by microangiopathic haemolytic anaemia, consumption thrombocytopenia and organ injury. It is caused by a severe deficiency of ADAMTS13, which can be either congenital or acquired. There is a plethora of things that can cause the acquired form, including medications and infections. Vaccines have also been shown to cause TTP. In the midst of the COVID-19 pandemic, with multiple new vaccines being developed and distributed to the masses, the medical community needs to be aware of adverse events associated with these new vaccines. We present a case of TTP following administration of the Moderna booster vaccine.


Subject(s)
Anemia, Hemolytic , COVID-19 , Purpura, Thrombotic Thrombocytopenic , Anemia, Hemolytic/complications , COVID-19/prevention & control , Humans , Immunization, Secondary/adverse effects , Pandemics , Purpura, Thrombotic Thrombocytopenic/chemically induced , Purpura, Thrombotic Thrombocytopenic/complications
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