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1.
Thromb Res ; 214: 115-121, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1815211

ABSTRACT

INTRODUCTION: With the advent of COVID-19 vaccines, hospitalization rates and progression to severe COVID-19 disease have reduced drastically. Most of the adverse events reported by the vaccine recipients were minor. However, autoimmune hematological complications such as vaccine-induced immune thrombotic thrombocytopenia (VITT), immune thrombocytopenic purpura (ITP) and TTP have also been reported post-COVID-19 vaccination. Given this, we sought to reflect on the existing cases of TTP, whether de novo or relapsing, reported after COVID-19 vaccination to further gain insight into any association, if present, and outcomes. METHODS: We searched PubMed, Embase, and Ebsco databases for published individual case reports on the occurrence or relapse of TTP after receiving any COVID-19 vaccine. A total of 23 articles (27 patients) were included in this qualitative analysis. RESULTS: The mean age for the patients who developed de novo TTP post-COVID-19 vaccination was 51.3 years. TTP episodes were seen mostly after BNT162b2 vaccine, followed by mRNA-1273 vaccine. All patients with immune TTP except one received plasma exchange (PLEX) and steroids. One patient passed away after two days of hospitalization, likely due to a sudden cardiovascular event. CONCLUSION: Our review underscores the importance of in-depth anamnesis before vaccination and outlines characteristics of predisposed individuals. Evaluation of post-vaccine thrombocytopenia must include the possibility of TTP given the associated fatality with this condition.


Subject(s)
COVID-19 , Purpura, Thrombocytopenic, Idiopathic , Purpura, Thrombotic Thrombocytopenic , Thrombosis , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Humans , Middle Aged , Purpura, Thrombocytopenic, Idiopathic/chemically induced , Purpura, Thrombotic Thrombocytopenic/etiology , SARS-CoV-2 , Thiamine , Thrombosis/etiology , Vaccination/adverse effects
4.
Pediatr Blood Cancer ; 69(6): e29681, 2022 06.
Article in English | MEDLINE | ID: covidwho-1772827

ABSTRACT

The mRNA COVID-19 vaccine and COVID-19 infection caused by the SARS-CoV-2 virus may be immunologic triggers for the development of thrombotic thrombocytopenic purpura (TTP). There is not yet literature that discusses TTP induced by COVID-19 vaccination or infection in pediatric or adolescent patients. We describe three adolescents presenting with TTP (both de novo and relapsed disease) following administration of the Pfizer COVID-19 vaccine or after COVID-19 infection. Our observations demonstrate that the Pfizer-BioNTech mRNA vaccine and COVID-19 infection can act as triggers for the development/relapse of both congenital and acquired TTP.


Subject(s)
COVID-19 , Purpura, Thrombotic Thrombocytopenic , Adolescent , COVID-19/complications , COVID-19 Vaccines/adverse effects , Child , Humans , Purpura, Thrombotic Thrombocytopenic/genetics , RNA, Messenger/genetics , SARS-CoV-2 , Vaccines, Synthetic
6.
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
7.
J Pediatr Hematol Oncol ; 44(3): e812-e815, 2022 04 01.
Article in English | MEDLINE | ID: covidwho-1758948

ABSTRACT

The understanding of coronavirus disease 2019 (COVID-19) immune dysregulation is evolving. Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease with alternations in both innate and adaptive immunity, probably caused by a complex interplay of genetics and environmental exposure with various triggers. A rare hematological complication of SLE as well as recently reported in an adult with COVID-19 is thrombotic thrombocytopenic purpura. We report a pediatric case with features suggestive of the multisystem inflammatory syndrome in children with coronary artery ectasia, thrombotic thrombocytopenic purpura, and new-onset SLE.


Subject(s)
COVID-19 , Lupus Erythematosus, Systemic , Purpura, Thrombotic Thrombocytopenic , Adult , COVID-19/complications , COVID-19/diagnosis , Child , Humans , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/diagnosis , Purpura, Thrombotic Thrombocytopenic/complications , Purpura, Thrombotic Thrombocytopenic/diagnosis , Systemic Inflammatory Response Syndrome/complications
13.
Intern Med ; 61(3): 407-412, 2022 Feb 01.
Article in English | MEDLINE | ID: covidwho-1666883

ABSTRACT

A 57-year-old man without underlying diseases presented with fatigue, loss of appetite, and jaundice 1 week after receiving the first dose of the BNT162b2 mRNA coronavirus disease 2019 (COVID-19) vaccine and showed hemolytic anemia with fragmented erythrocytes and severe thrombocytopenia 2 weeks after receiving the vaccine. An a disintegrin-like and metalloproteinase with thrombospondin type 1 motifs 13 (ADAMTS13) activity level of <10% and ADAMTS13 inhibitor positivity confirmed the diagnosis of acquired thrombotic thrombocytopenic purpura (TTP). Combination therapy with plasma exchange, corticosteroid, and rituximab improved the clinical outcome. We herein report the first Japanese case of TTP possibly associated with vaccination. Physicians should be alert for this rare but life-threatening hematological complication following COVID-19 vaccination.


Subject(s)
/adverse effects , COVID-19 , Purpura, Thrombotic Thrombocytopenic , ADAMTS13 Protein , COVID-19/prevention & control , Humans , Japan , Male , Middle Aged , Plasma Exchange , Purpura, Thrombotic Thrombocytopenic/chemically induced , Purpura, Thrombotic Thrombocytopenic/diagnosis , Vaccination/adverse effects
14.
Bol Med Hosp Infant Mex ; 79(2): 123-128, 2022 Mar 03.
Article in English | MEDLINE | ID: covidwho-1650954

ABSTRACT

BACKGROUND: Acquired thrombotic thrombocytopenic purpura (TTP) is a rare disease. In middle and low-income countries, specific resources are required for its diagnosis due to the lack of diagnostic tests and the variable response to plasma exchange, especially in the context of the new SARS-CoV-2 pandemic. CASE REPORT: We report the case of a 9-year-old male Hispanic patient with SARS-CoV-2 infection, atypical presentation, and multisystem involvement, thrombotic microangiopathy with dermal manifestations, hematologic, renal, and neurologic involvement. The patient was followed up after SARS-CoV-2 infection, the PLASMIC score was applied, and a genetic study was performed. Ventilation and hemodynamic support, corticotherapy, immunoglobulins, plasma exchange, renal replacement therapy, and monoclonal antibodies were given without favorable response. CONCLUSIONS: TTP associated with SARS-CoV-2 in the pediatric population is rare. However, resources for the diagnosis, support, and management of patients with TTP are required to avoid fatal outcomes.


INTRODUCCIÓN: La púrpura trombocitopénica trombótica (PTT) adquirida es una enfermedad poco frecuente. En los países de mediano y bajo estatus económico se requieren recursos para el diagnóstico de la PTT, debido a la falta de pruebas diagnósticas y a la respuesta variable al recambio plasmático, especialmente en el contexto de la pandemia por el nuevo SARS-CoV-2. CASO CLÍNICO: Paciente de sexo masculino, de 9 años, hispano, con infección por SARS-CoV-2, presentación atípica y afectación multisistémica, microangiopatía trombótica con manifestaciones dérmicas, y compromiso hematológico, renal y neurológico. Se dio seguimiento posinfección por SARS-CoV-2, se aplicó la escala PLASMIC y se realizó un estudio genético. Se aplicaron soporte ventilatorio y hemodinámico, corticoterapia, inmunoglobulinas, recambio plasmático, terapia de reemplazo renal y anticuerpos monoclonales, sin respuesta favorable. CONCLUSIONES: La PTT asociada al SARS-CoV-2 en la población pediátrica es poco frecuente. Aun así, se requieren recursos para el diagnóstico, el soporte y el manejo de los pacientes con PTT para evitar desenlaces fatales.


Subject(s)
COVID-19 , Purpura, Thrombotic Thrombocytopenic , COVID-19/complications , COVID-19/diagnosis , COVID-19/therapy , Child , Critical Illness , Humans , Male , Peru , Purpura, Thrombotic Thrombocytopenic/complications , Purpura, Thrombotic Thrombocytopenic/diagnosis , Purpura, Thrombotic Thrombocytopenic/therapy , SARS-CoV-2
15.
Rinsho Ketsueki ; 62(12): 1688-1693, 2021.
Article in Japanese | MEDLINE | ID: covidwho-1622835

ABSTRACT

A 95-year-old male developed general subcutaneous petechiae, tongue hematoma, and melena two days after receiving the second BNT162b2 mRNA COVID-19 vaccine. Two days later, his platelet count decreased to below 1,000/µl. Laboratory testing was positive for a slight increase in D-dimer, Helicobacter pylori (H. pylori) immunoglobulin G (IgG) antibody, lupus anticoagulant, and anticardiolipin IgG antibody levels. There were no severe infections or symptomatic thrombosis. Platelet transfusions were transiently effective. He was diagnosed with newly developed immune thrombocytopenia (ITP). We administered prednisolone (PSL) at 0.5 mg/kg/day and intravenous immunoglobulin (IVIG) at 0.4 g/kg/day. From the following day, his platelet count rapidly increased, with an improvement in bleeding tendency. H. pylori was eradicated after platelet count recovery. Thrombocytopenia did not relapse although PSL was tapered three months later. Causes of thrombocytopenia after SARS-CoV-2 vaccination include ITP, vaccine-induced immune thrombotic thrombocytopenia, and thrombotic thrombocytopenic purpura. Differential diagnosis is important to determine the proper therapy. Case reports of newly diagnosed ITP after SARS-CoV-2 vaccination have been increasing recently. In these cases, including ours, the responses to steroids and IVIG were good. Further follow-up studies are needed to manage thrombocytopenia following SARS-CoV-2 vaccination.


Subject(s)
COVID-19 , Purpura, Thrombocytopenic, Idiopathic , Purpura, Thrombotic Thrombocytopenic , Aged, 80 and over , COVID-19 Vaccines , Humans , Male , Purpura, Thrombocytopenic, Idiopathic/diagnosis , RNA, Messenger , SARS-CoV-2 , Vaccination/adverse effects
17.
J Med Case Rep ; 15(1): 587, 2021 Dec 13.
Article in English | MEDLINE | ID: covidwho-1571927

ABSTRACT

BACKGROUND: Atypical hemolytic uremic syndrome is an exceedingly rare thrombotic microangiopathy caused by accelerated activation of the alternative complement pathway. CASE PRESENTATION: Here, we report two cases of patients presenting with suspected atypical hemolytic uremic syndrome precipitated by coronavirus disease 2019 infection. The first patient, a 25-year-old Hispanic male, had one prior episode of thrombotic microangiopathy presumed to be atypical hemolytic uremic syndrome precipitated by influenza A, and re-presented with thrombocytopenia, microangiopathic hemolytic anemia, nonoliguric renal failure, and normal ADAMTS13 activity, with confirmed coronavirus disease 2019 positivity. The second patient, a 31-year-old Caucasian female, had no personal history of thrombotic microangiopathy, though reported a family history of suspected atypical hemolytic uremic syndrome. She presented with similar laboratory derangements, oliguric renal failure requiring hemodialysis, and confirmed coronavirus disease 2019 positivity. Both patients were treated with eculizumab with complete resolution of their hematologic and renal complications. CONCLUSION: To our knowledge, this represents the largest case series of atypical hemolytic uremic syndrome precipitated by coronavirus disease 2019 in adults.


Subject(s)
Atypical Hemolytic Uremic Syndrome , COVID-19 , Purpura, Thrombotic Thrombocytopenic , Thrombotic Microangiopathies , Adult , Atypical Hemolytic Uremic Syndrome/diagnosis , Atypical Hemolytic Uremic Syndrome/drug therapy , Female , Humans , Male , SARS-CoV-2
18.
BMC Nephrol ; 22(1): 411, 2021 12 11.
Article in English | MEDLINE | ID: covidwho-1571745

ABSTRACT

BACKGROUND: We report a case of a 25-year-old male patient, who developed acquired thrombotic thrombocytopenic purpura (aTTP) after receiving a first dose of mRNA-based SARS-CoV-2 vaccine Spikevax (mRNA-1273, Moderna Biotech, USA). While this is the first case in literature describing a case of aTTP after receiving the Spikevax vaccine, there are two other cases after mRNA-based Covid-19 vaccine and two after adenoviral SARS-CoV-2 vaccine. CASE PRESENTATION: The patient presented with persisting malaise, fever, headache, word-finding difficulties, nausea, vomiting, petechial bleeding, and hematuria 13 days after receiving a first dose of vaccination. Laboratory testing showed low platelet count, Coombs-negative hemolytic anemia, and mild acute kidney injury. We excluded vaccine induced immune thrombotic thrombocytopenia (VITT) as another important differential diagnosis and the final diagnosis was established after ADAMTS-13 (A Disintegrin And Metalloproteinase with a ThromboSpondin type 1 motif, member 13) activity was found to be < 1% (reference range > 40%) and ADAMTS-13 antibodies being 72.2 IU/L (reference range < 12 IU/L). We initiated empiric therapy of plasmapheresis and corticosteroids on admission and started caplacizumab the day after. The patient's thrombocyte count normalized 3 days after admission, hemolysis and acute kidney injury resolved after 2 weeks. The patient received 2 doses of rituximab (1 g each) after the diagnosis of immune TTP was established. One month after the initial presentation, the patient is in good overall condition, but still receives daily caplacizumab due to ADAMTS-13 activity of < 1%. CONCLUSIONS: Low platelet count after vaccination against SARS-CoV-2 has gained attraction after vaccine-induced immune thrombotic thrombocytopenia (VITT) has been described as a rare but severe complication of adenoviral-based vaccines. Thrombotic thrombocytopenic purpura (TTP) is an important differential diagnosis, but there are only few reports of TTP following SARS-CoV-2 vaccination. Despite pathophysiological and clinical differences of both entities, diagnostic uncertainty can result in the acute setting, since they share main symptoms such as headache and neurological alterations in addition to thrombocytopenia. In difference to other cases reported, this patient developed first symptoms of TTP as early as 4 days after vaccination, which suggests that vaccination merely acted as trigger for occult TTP, instead of truly inducing an autoimmunological process.


Subject(s)
/adverse effects , COVID-19/prevention & control , Purpura, Thrombotic Thrombocytopenic/chemically induced , Adult , Humans , Male , Platelet Count , Purpura, Thrombotic Thrombocytopenic/therapy , SARS-CoV-2
19.
Blood Purif ; 50(3): 290-297, 2021.
Article in English | MEDLINE | ID: covidwho-1533118

ABSTRACT

The principles and use of plasmapheresis are often little understood by intensivists. We propose to review the principles, the main indications, and the methods of using this technique.


Subject(s)
Critical Care/methods , Plasma Exchange/methods , Animals , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/therapy , COVID-19/therapy , Equipment Design , Guillain-Barre Syndrome/therapy , Humans , Liver Failure, Acute/therapy , Membranes, Artificial , Plasma Exchange/instrumentation , Purpura, Thrombotic Thrombocytopenic/therapy
20.
Intern Med ; 61(3): 407-412, 2022 Feb 01.
Article in English | MEDLINE | ID: covidwho-1528762

ABSTRACT

A 57-year-old man without underlying diseases presented with fatigue, loss of appetite, and jaundice 1 week after receiving the first dose of the BNT162b2 mRNA coronavirus disease 2019 (COVID-19) vaccine and showed hemolytic anemia with fragmented erythrocytes and severe thrombocytopenia 2 weeks after receiving the vaccine. An a disintegrin-like and metalloproteinase with thrombospondin type 1 motifs 13 (ADAMTS13) activity level of <10% and ADAMTS13 inhibitor positivity confirmed the diagnosis of acquired thrombotic thrombocytopenic purpura (TTP). Combination therapy with plasma exchange, corticosteroid, and rituximab improved the clinical outcome. We herein report the first Japanese case of TTP possibly associated with vaccination. Physicians should be alert for this rare but life-threatening hematological complication following COVID-19 vaccination.


Subject(s)
/adverse effects , COVID-19 , Purpura, Thrombotic Thrombocytopenic , ADAMTS13 Protein , COVID-19/prevention & control , Humans , Japan , Male , Middle Aged , Plasma Exchange , Purpura, Thrombotic Thrombocytopenic/chemically induced , Purpura, Thrombotic Thrombocytopenic/diagnosis , Vaccination/adverse effects
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