Refractory vaccine-induced immune thrombotic thrombocytopenia (VITT) managed with delayed therapeutic plasma exchange (TPE).
J Clin Apher
; 37(1): 117-121, 2022 Feb.
Article
in English
| MEDLINE | ID: covidwho-1473857
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
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Plasma Exchange
/
Vaccination
/
Purpura, Thrombocytopenic, Idiopathic
/
Ad26COVS1
Type of study:
Case report
Topics:
Vaccines
Limits:
Humans
/
Male
/
Middle aged
Language:
English
Journal:
J Clin Apher
Year:
2022
Document Type:
Article
Affiliation country:
Jca.21945
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