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Detection of Platelet-Activating Antibodies Associated with Vaccine-Induced Thrombotic Thrombocytopenia by Flow Cytometry: An Italian Experience.
Cesari, Francesca; Sorrentino, Silvia; Gori, Anna Maria; Rogolino, Angela; De Cristofaro, Raimondo; Giusti, Betti; Sticchi, Elena; De Candia, Erica; Marcucci, Rossella.
  • Cesari F; Atherothrombotic Disease Unit, Department of Experimental and Clinical Medicine, University of Florence, Azienda Ospedaliera Universitaria Careggi, 50141 Florence, Italy.
  • Sorrentino S; Malattie Emorragiche e Trombotiche, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy.
  • Gori AM; Atherothrombotic Disease Unit, Department of Experimental and Clinical Medicine, University of Florence, Azienda Ospedaliera Universitaria Careggi, 50141 Florence, Italy.
  • Rogolino A; Atherothrombotic Disease Unit, Department of Experimental and Clinical Medicine, University of Florence, Azienda Ospedaliera Universitaria Careggi, 50141 Florence, Italy.
  • De Cristofaro R; Malattie Emorragiche e Trombotiche, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy.
  • Giusti B; Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
  • Sticchi E; Atherothrombotic Disease Unit, Department of Experimental and Clinical Medicine, University of Florence, Azienda Ospedaliera Universitaria Careggi, 50141 Florence, Italy.
  • De Candia E; Atherothrombotic Disease Unit, Department of Experimental and Clinical Medicine, University of Florence, Azienda Ospedaliera Universitaria Careggi, 50141 Florence, Italy.
  • Marcucci R; Malattie Emorragiche e Trombotiche, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy.
Viruses ; 14(6)2022 05 24.
Article in English | MEDLINE | ID: covidwho-1911607
ABSTRACT
Rare cases of thrombocytopenia and thrombosis after anti-COVID-19 adenovirus-associated mRNA vaccines (VITT) due to platelet-activating anti-platelet-factor 4 (PF4)/polyanion antibodies have been reported. VITT laboratory diagnosis, similarly to heparin-induced thrombocytopenia (HIT) diagnosis, requires immunoassays for anti-PF4/polyanion antibodies identification, such as ELISA assays and platelet-activating functional tests, such as heparin-induced platelet activation test (HIPA), to confirm their pathogenicity. We compared the flow cytometry (FC) measurement of platelet p-selectin exposure to the gold standard functional test HIPA for diagnosis confirmation in 13 patients with a clinical VITT syndrome (6M/7F; median age 56 (33-78)) who resulted positive to anti-PF4/polyanion antibodies ELISA assays (12/13). FC and HIPA similarly identified three different patterns (1) a typical non-heparin-dependent VITT pattern (seven and six patients by FC and HIPA, respectively); (2) low/no platelet activation in patients under IvIg therapy (five out of five and two out of four patients by FC and HIPA, respectively); (3) a HIT pattern. Antibodies investigated by FC became negative after 7, 17, and 24 days of therapy in three patients. FC measurement of P-selectin exposure was as sensitive as HIPA but simpler to detect anti-PF4/polyanion antibodies in VITT patients. FC could reliably discriminate VITT from HIT, thus helping for the choice of the anticoagulant.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Thrombocytopenia / Thrombosis / COVID-19 Vaccines / Antibodies Type of study: Diagnostic study / Prognostic study Topics: Vaccines Limits: Humans / Middle aged Language: English Year: 2022 Document Type: Article Affiliation country: V14061133

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Thrombocytopenia / Thrombosis / COVID-19 Vaccines / Antibodies Type of study: Diagnostic study / Prognostic study Topics: Vaccines Limits: Humans / Middle aged Language: English Year: 2022 Document Type: Article Affiliation country: V14061133