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Bokel J, Martins-Gonçalves R, Grinsztejn E, Mendes-de-Almeida DP, Hoagland B, Cardoso SW, Geraldo KM, Coutinho SN, Georg I, Oliveira MH, Dos Santos Souza F, Sacramento CQ, Rozini SV, Vizzoni AG, Veloso V, Bozza PT, Grinsztejn B. Anti-PF4 positivity and platelet activation after Ad26.COV2·S vaccination in Brazil. Vaccine 2024:126175. [PMID: 39107160 DOI: 10.1016/j.vaccine.2024.126175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 04/13/2024] [Accepted: 07/22/2024] [Indexed: 08/09/2024]
Abstract
INTRODUCTION The Ad26.COV2·S (Janssen/Johnson & Johnson) COVID-19 vaccine, has been rarely associated with vaccine-induced immune thrombocytopenia and thrombosis (VITT). We investigated the prevalence of anti-PF4 antibody positivity, thrombocytopenia, D-dimer elevation, plasmatic thromboinflammatory markers, and platelet functional assays following Ad26.COV2·S vaccination in Rio de Janeiro, Brazil. METHODS From July to September 2021, participants were assessed prior, 1, and 3 weeks post-vaccination. Platelet count and D-dimer were measured at each visit and anti-PF4 at week 3. A positive anti-PF4 prompted retrospective testing of the sample from week 0. Individuals with new thrombocytopenia or elevated D-dimer, positive anti-PF4, and 38 matched controls without laboratory abnormalities were evaluated for plasmatic p-selectin, tissue factor, and functional platelet activation assays. RESULTS 630 individuals were included; 306 (48.57%) females, median age 28 years. Forty-two (6.67%) presented ≥1 laboratory abnormality in week 1 or 3. Five (0.79%) had thrombocytopenia, 31 (4.91%) elevated D-dimer, and 9 (1.57%) had positive anti-PF4 at week 3. Individuals with laboratory abnormalities and controls showed a slight increase in plasmatic p-selectin and tissue factor. Ten individuals with laboratory abnormalities yielded increased surface expression of p-selectin, and their ability to activate platelets in a FcγRIIa dependent manner was further evaluated. Two were partially inhibited by high concentrations of heparin and blockage of FcγRII with IV.3 antibody. Plasma obtained before vaccination produced similar results, suggesting a lack of association with vaccination. CONCLUSIONS Vaccination with Ad26.COV2·S vaccine led to a very low frequency of low-titer positive anti-PF4 antibodies, elevation of D-dimer, and mild thrombocytopenia, with no associated clinically relevant increase in thromboinflammatory markers and platelet activation.
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Affiliation(s)
- Joanna Bokel
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.
| | | | | | - Daniela P Mendes-de-Almeida
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Sandra Wagner Cardoso
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Kim Mattos Geraldo
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Sandro Nazer Coutinho
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Ingebourg Georg
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Maria Helena Oliveira
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Flávia Dos Santos Souza
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Carolina Q Sacramento
- Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Stephane V Rozini
- Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Alexandre G Vizzoni
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Valdiléa Veloso
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Patrícia T Bozza
- Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
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Meier RT, Porcelijn L, Hofstede-van Egmond S, Caram-Deelder C, Coutinho JM, Henskens YMC, Kruip MJHA, Stroobants AK, Zwaginga JJ, van der Schoot CE, de Haas M, Kapur R. Antibodies against Platelet Glycoproteins in Clinically Suspected VITT Patients. Antibodies (Basel) 2024; 13:35. [PMID: 38804303 PMCID: PMC11130846 DOI: 10.3390/antib13020035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/02/2024] [Accepted: 04/16/2024] [Indexed: 05/29/2024] Open
Abstract
Vaccine-induced thrombotic thrombocytopenia (VITT) is a rare but severe complication following COVID-19 vaccination, marked by thrombocytopenia and thrombosis. Analogous to heparin-induced thrombocytopenia (HIT), VITT shares similarities in anti-platelet factor 4 (PF4) IgG-mediated platelet activation via the FcγRIIa. To investigate the involvement of platelet-antibodies in VITT, we analyzed the presence of platelet-antibodies directed against glycoproteins (GP)IIb/IIIa, GPV and GPIb/IX in the serum of 232 clinically suspected VITT patients determined based on (suspicion of) occurrence of thrombocytopenia and/or thrombosis in relation to COVID-19 vaccination. We found that 19% of clinically suspected VITT patients tested positive for anti-platelet GPs: 39%, 32% and 86% patients tested positive for GPIIb/IIIa, GPV and GPIb/IX, respectively. No HIT-like VITT patients (with thrombocytopenia and thrombosis) tested positive for platelet-antibodies. Therefore, it seems unlikely that platelet-antibodies play a role in HIT-like anti-PF4-mediated VITT. Platelet-antibodies were predominantly associated with the occurrence of thrombocytopenia. We found no association between the type of vaccination (adenoviral vector vaccine versus mRNA vaccine) or different vaccines (ChAdOx1 nCoV-19, Ad26.COV2.S, mRNA-1273, BTN162b2) and the development of platelet-antibodies. It is essential to conduct more research on the pathophysiology of VITT, to improve diagnostic approaches and identify preventive and therapeutic strategies.
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Affiliation(s)
- Romy T. Meier
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, 1066 CX Amsterdam, The Netherlands; (R.T.M.); (C.E.v.d.S.)
| | - Leendert Porcelijn
- Sanquin Diagnostic Services, Department of Immunohematology Diagnostics, Sanquin, 1066 CX Amsterdam, The Netherlands; (L.P.); (S.H.-v.E.); (M.d.H.)
| | - Suzanne Hofstede-van Egmond
- Sanquin Diagnostic Services, Department of Immunohematology Diagnostics, Sanquin, 1066 CX Amsterdam, The Netherlands; (L.P.); (S.H.-v.E.); (M.d.H.)
| | - Camila Caram-Deelder
- Department of Clinical Epidemiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | | | - Yvonne M. C. Henskens
- Central Diagnostic Laboratory, Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands;
| | - Marieke J. H. A. Kruip
- Department of Haematology, Erasmus MC, Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands;
| | - An K. Stroobants
- Department of Clinical Chemistry, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
| | - Jaap J. Zwaginga
- Department of Hematology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | - C. Ellen van der Schoot
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, 1066 CX Amsterdam, The Netherlands; (R.T.M.); (C.E.v.d.S.)
| | - Masja de Haas
- Sanquin Diagnostic Services, Department of Immunohematology Diagnostics, Sanquin, 1066 CX Amsterdam, The Netherlands; (L.P.); (S.H.-v.E.); (M.d.H.)
- Department of Hematology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | - Rick Kapur
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, 1066 CX Amsterdam, The Netherlands; (R.T.M.); (C.E.v.d.S.)
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Recommendations on the Management of Patients with Immune Thrombocytopenia (ITP) in the Context of SARS-CoV-2 Infection and Vaccination: Consensus Guidelines from a Spanish ITP Expert Group. Infect Dis Ther 2022; 12:303-315. [PMID: 36520323 PMCID: PMC9753022 DOI: 10.1007/s40121-022-00745-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022] Open
Abstract
Primary immune thrombocytopenia (ITP) is an acquired autoimmune disease with highly variable presentation, characteristics, and clinical course. Thrombocytopenia is a common complication of many viral infections, including SARS-CoV-2. In addition, both de novo ITP and exacerbation of ITP after vaccination against SARS-CoV-2 have been reported. Patients infected with SARS-CoV-2 develop a prothrombotic coagulopathy called COVID-19-associated coagulopathy (CAC). In addition, autoimmune hematological disorders secondary to SARS-CoV-2 infection, mainly ITP and autoimmune hemolytic anemia (AIHA), have been described. Furthermore, SARS-CoV-2 infection has been associated with exacerbation of autoimmune processes, including ITP. In fact, there is evidence of a high relapse rate in patients with preexisting ITP and COVID-19. As for vaccination against SARS-CoV-2, hematological adverse events (HAE) are practically anecdotal. The most common HAE is thrombocytopenia-associated thrombosis syndrome (TTS) linked to vectored virus vaccines. Other HAEs are very rare, but should be considered in patients with previous complement activation disease or autoimmunity. In patients with ITP who are vaccinated against SARS-CoV-2, the main complication is exacerbation of ITP and the bleeding that may result. In fact, this complication occurs in 12% of patients, with splenectomized and refractory patients with more than five lines of previous treatment and platelet counts below 50 × 109/L being the most vulnerable. We conclude that, in general, there is no greater risk of severe SARS-CoV-2 infection in ITP patients than in the general population. Furthermore, no changes are advised in patients with stable ITP, the use of immunosuppressants is discouraged unless there is no other therapeutic option, and patients with ITP are not contraindicated for vaccination against COVID-19.
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Latef T, Howard L, Loke C, Tsui E. Immune thrombocytopaenic purpura following the second dose of Pfizer COVID-19 vaccine. BMJ Case Rep 2022. [PMCID: PMC9442476 DOI: 10.1136/bcr-2022-249477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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.
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Affiliation(s)
- Taroob Latef
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts, USA
| | - Leslie Howard
- Division of Hematology and Oncology, Baystate Medical Center, Springfield, Massachusetts, USA
| | - Chandravathi Loke
- Division of Hematology and Oncology, Baystate Medical Center, Springfield, Massachusetts, USA
| | - Edison Tsui
- Division of Hematology and Oncology, Baystate Medical Center, Springfield, Massachusetts, USA
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Murali A, Wong P, Gilbar PJ, Mangos HM. Acquired Hemophilia A following Pfizer-BioNTech SARS CoV-2 mRNA vaccine, successfully treated with prednisolone and rituximab. J Oncol Pharm Pract 2022; 28:1450-1453. [PMID: 35088622 DOI: 10.1177/10781552221075545] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Acquired haemophilia A (AHA) is a rare bleeding disorder, characterised by the presence of autoantibodies to clotting factor VIII (FVIII). AHA can be idiopathic or occur in the context of malignancy, autoimmune disease, drugs, or pregnancy. Recently, cases of AHA following both COVID-19 infection and vaccination have been reported. CASE REPORT We report the case of a 95-year-old female who was immunised with the Pfizer-BioNTech SARS CoV-2 mRNA vaccine, with doses given three weeks apart. Spontaneous bruising over her extremities appeared one week after the initial dose, with hospital admission occurring three weeks after the second. Examination revealed a large haematoma on the dorsum of the right hand with resultant bleeding and widespread ecchymoses. Investigations confirmed a diagnosis of AHA. MANAGEMENT AND OUTCOME Initial management included high dose prednisolone, recombinant Factor VIII and tranexamic acid. There was no significant clinical improvement after three days, so intravenous rituximab 100 mg weekly for four weeks was commenced. The activated partial thromboplastin time (aPTT) normalised after two doses and Factor VIII level reached 0.68U/ml on day + 22. The patient was successfully discharged from hospital after 37 days. DISCUSSION Four cases of AHA following administration of COVID mRNA vaccines (Pfizer and Moderna) have been documented. AHA should be a differential in patients presenting with bleeding following COVID-19 vaccination, in the presence of a normal platelet count. Rapid recognition, prompt initiation of immunosuppressive treatment and rigorous supportive cares are required to minimise morbidity and mortality.
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Affiliation(s)
- Aarya Murali
- School of Medicine, 1974University of Queensland, St Lucia, Queensland, Australia
- Cancer Care Services, Toowoomba Hospital, Toowoomba, Queensland, Australia
| | - Philip Wong
- School of Medicine, 1974University of Queensland, St Lucia, Queensland, Australia
- Cancer Care Services, Toowoomba Hospital, Toowoomba, Queensland, Australia
| | - Peter J Gilbar
- School of Medicine, 1974University of Queensland, St Lucia, Queensland, Australia
- Cancer Care Services, Toowoomba Hospital, Toowoomba, Queensland, Australia
| | - Hilda M Mangos
- Cancer Care Services, Toowoomba Hospital, Toowoomba, Queensland, Australia
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Adverse Events following Immunization with COVID-19 Vaccines: A Narrative Review. BIOMED RESEARCH INTERNATIONAL 2022; 2022:2911333. [PMID: 36017393 PMCID: PMC9398801 DOI: 10.1155/2022/2911333] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 05/08/2022] [Accepted: 07/20/2022] [Indexed: 12/14/2022]
Abstract
Numerous COVID-19 vaccines are being administered to people around the world. Adverse events following immunization (AEFI) with COVID-19 vaccines have been reported by health care workers as well as surveillance bodies. A wealth of information on the efficacy and safety of vaccines exists in the literature, and the knowledge in this sector is growing exponentially. A narrative literature review was conducted on sources accessed from PubMed, Google Scholar, and Cochrane Review from March 2021 to July 2021. This review is aimed at describing AEFI associated with currently available COVID-19 vaccines, with an emphasis on narrating probable AEFI, and at assisting in a better understanding of the COVID-19 vaccines.
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Liu W, Wu T, Xue F, Tian H, Song R, Bai H. Immune thrombocytopenic purpura induced by the COVID‑19 vaccine after the second dose in a 78‑year‑old patient: A case report. Exp Ther Med 2022; 24:580. [PMID: 35949340 PMCID: PMC9353547 DOI: 10.3892/etm.2022.11517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/27/2022] [Indexed: 01/08/2023] Open
Affiliation(s)
- Wenhui Liu
- Department of Hematology, The 940th Hospital of Joint Logistics Support Force of The Chinese People's Liberation Army, Lanzhou, Gansu 730050, P.R. China
| | - Tao Wu
- Department of Hematology, The 940th Hospital of Joint Logistics Support Force of The Chinese People's Liberation Army, Lanzhou, Gansu 730050, P.R. China
| | - Feng Xue
- Department of Hematology, The 940th Hospital of Joint Logistics Support Force of The Chinese People's Liberation Army, Lanzhou, Gansu 730050, P.R. China
| | - Hongjuan Tian
- Department of Hematology, The 940th Hospital of Joint Logistics Support Force of The Chinese People's Liberation Army, Lanzhou, Gansu 730050, P.R. China
| | - Rui Song
- Department of Hematology, The 940th Hospital of Joint Logistics Support Force of The Chinese People's Liberation Army, Lanzhou, Gansu 730050, P.R. China
| | - Hai Bai
- Department of Hematology, The 940th Hospital of Joint Logistics Support Force of The Chinese People's Liberation Army, Lanzhou, Gansu 730050, P.R. China
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The Frequency and Patterns of Post-COVID-19 Vaccination Syndrome Reveal Initially Mild and Potentially Immunocytopenic Signs in Primarily Young Saudi Women. Vaccines (Basel) 2022; 10:vaccines10071015. [PMID: 35891179 PMCID: PMC9323608 DOI: 10.3390/vaccines10071015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 12/14/2022] Open
Abstract
Vaccination is the most promising approach for ending or containing the SARS-CoV-2 pandemic. However, serious post-COVID-19 vaccine reactions, including immunocytopenia (ITP) syndrome, have been increasingly reported. Several factors cause increased risks including multiple doses, age-dependent heterogeneity in immune-responses, platelet cross-reactions with microbial components, and Long-COVID syndrome. Thus, in the absence of widely available specific therapeutics, vigilance is important while more studies are needed. Using a structured questionnaire sent to different regions in Saudi Arabia, we conducted a comprehensive investigation on the frequency, rates, disease patterns, and patient demographics of post-COVID-19 vaccine side effects on febrile patients after administration three major vaccines. Results indicated that the majority of respondents administered Pfizer BioNtech vaccine (81%, n = 809); followed by AstraZeneca (16%, n = 155); and Moderna (3%, n = 34). Overall 998 participants, 74% (n = 737) showed no serious symptoms; however, 26.2% (n = 261) revealed typical syndromes. In a focused group of 722 participants, the following rates were identified: shortness of breath (20%), bruises or bleeding (18%), inattention (18%), GIT symptoms (17.6%), skin irritation (8.6%), and anosmia and ageusia (8%) were the most prominent among those who showed typical symptoms. The onset time was mostly between 1–3 days in 49% (n = 128), followed by 4–7 days in 21.8% (n = 57), 8–14 days in 16.5% (n = 43), and more than a month in 12.6% (n = 33). The onsets occurred mostly after the first, second, or both doses, 9%, 10%, and 7% of participants, respectively. The frequency of symptoms was significantly higher after Moderna® vaccine (p-value = 0.00006) and it was significantly lower in participants who received Pfizer (p-value = 0.00231). We did not find significant difference in symptoms related to differences in regions. Similarly, the region, age, sex, education, and nationality had no influence on the dose and onset timings. The findings of this study have significant clinical implications in disease management strategies, preventive measures, and vaccine development. Future vertical studies would reveal more insights into the mechanisms of post-COVID-19 vaccine syndrome.
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Said KB, Alsolami A, Alshammari F, Alreshidi FS, Fathuldeen A, Alrashid F, Bashir AI, Osman S, Aboras R, Alshammari A, Alshammari T, Alharbi SF. Selective COVID-19 Coinfections in Diabetic Patients with Concomitant Cardiovascular Comorbidities Are Associated with Increased Mortality. Pathogens 2022; 11:508. [PMID: 35631029 PMCID: PMC9145452 DOI: 10.3390/pathogens11050508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/15/2022] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
Coinfections and comorbidities add additional layers of difficulties into the challenges of COVID-19 patient management strategies. However, studies examining these clinical conditions are limited. We have independently investigated the significance of associations of specific bacterial species and different comorbidities in the outcome and case fatality rates among 129 hospitalized comorbid COVID-19 patients. For the first time, to best of our knowledge, we report on the predominance of Klebsiella pneumoniae and Acinetobacter baumannii in COVID-19 non-survival diabetic patients The two species were significantly associated to COVID-19 case fatality rates (p-value = 0.02186). Coinfection rates of Klebsiella pneumoniae and Acinetobacter baumannii in non-survivors were 93% and 73%, respectively. Based on standard definitions for antimicrobial resistance, Klebsiella pneumoniae and Acinetobacter baumannii were classified as multidrug resistant and extremely drug resistant, respectively. All patients died at ICU with similar clinical characterisitics. Of the 28 major coinfections, 24 (85.7%) were in non-survivor diabetic patients, implying aggravating and worsening the course of COVID-19. The rates of other comorbidities varied: asthma (47%), hypertension (79.4%), ischemic heart disease (71%), chronic kidney disease (35%), and chronic liver disease (32%); however, the rates were higher in K. pneumoniae and were all concomitantly associated to diabetes. Other bacterial species and comorbidities did not have significant correlation to the outcomes. These findings have highly significant clinical implications in the treatment strategies of COVID-19 patients. Future vertical genomic studies would reveal more insights into the molecular and immunological mechanisms of these frequent bacterial species. Future large cohort multicenter studies would reveal more insights into the mechanisms of infection in COVID-19.
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Affiliation(s)
- Kamaleldin B. Said
- Department of Pathology and Microbiology, College of Medicine, University of Ha’il, Ha’il 55476, Saudi Arabia; (A.A.); (T.A.); (S.F.A.)
- Department of Genomics, Bioinformatics and Systems Biology, Carleton University, 1125 Colonel-By Drive, Ottawa, ON K1S 5B6, Canada
- ASC Molecular Bacteriology, McGill University, 21111 Lakeshore Rd, Montreal, QC H9X 3L9, Canada
| | - Ahmed Alsolami
- Department of Internal Medicine, College of Medicine, University of Ha’il, Ha’il 55476, Saudi Arabia;
| | - Fawwaz Alshammari
- Department of Dermatology, College of Medicine, University of Ha’il, Ha’il 55476, Saudi Arabia;
| | - Fayez Saud Alreshidi
- Department of Family, Community Medicine, College of Medicine, University of Ha’il, Ha’il 55476, Saudi Arabia; (F.S.A.); (R.A.)
| | - Anas Fathuldeen
- Department of Plastic Surgery, College of Medicine, University of Ha’il, Ha’il 55476, Saudi Arabia;
| | - Fawaz Alrashid
- Department of Surgery, College of Medicine, University of Ha’il, Ha’il 55476, Saudi Arabia;
| | - Abdelhafiz I. Bashir
- Department of Physiology, College of Medicine, University of Ha’il, Ha’il 55476, Saudi Arabia;
| | - Sara Osman
- Department of Internal Medicine, Winchester Hospital 41 Highland Avenue, Winchester, MA 01890, USA;
| | - Rana Aboras
- Department of Family, Community Medicine, College of Medicine, University of Ha’il, Ha’il 55476, Saudi Arabia; (F.S.A.); (R.A.)
| | - Abdulrahman Alshammari
- Department of Pathology and Microbiology, College of Medicine, University of Ha’il, Ha’il 55476, Saudi Arabia; (A.A.); (T.A.); (S.F.A.)
| | - Turki Alshammari
- Department of Pathology and Microbiology, College of Medicine, University of Ha’il, Ha’il 55476, Saudi Arabia; (A.A.); (T.A.); (S.F.A.)
| | - Sultan F. Alharbi
- Department of Pathology and Microbiology, College of Medicine, University of Ha’il, Ha’il 55476, Saudi Arabia; (A.A.); (T.A.); (S.F.A.)
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Lassandro G, Carriero F, Palladino V, Vecchio GCD, Giordano P. Quick drop of platelet counts in children with chronic immune thrombocytopenia after COVID-19 mRNA vaccination: case reports. Clin Exp Vaccine Res 2022; 11:290-293. [DOI: 10.7774/cevr.2022.11.3.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 04/30/2022] [Indexed: 11/22/2022] Open
Affiliation(s)
- Giuseppe Lassandro
- Department Interdisciplinary of Medicine, Pediatric Unit “B. Trambusti”, University of Bari “Aldo Moro”, Bari, Italy
| | - Francesco Carriero
- Department Interdisciplinary of Medicine, Pediatric Unit “B. Trambusti”, University of Bari “Aldo Moro”, Bari, Italy
| | - Valentina Palladino
- Department Interdisciplinary of Medicine, Pediatric Unit “B. Trambusti”, University of Bari “Aldo Moro”, Bari, Italy
| | - Giovanni Carlo Del Vecchio
- Department Interdisciplinary of Medicine, Pediatric Unit “B. Trambusti”, University of Bari “Aldo Moro”, Bari, Italy
| | - Paola Giordano
- Department Interdisciplinary of Medicine, Pediatric Unit “B. Trambusti”, University of Bari “Aldo Moro”, Bari, Italy
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Immune Thrombocytopenia Induced by the Chimpanzee Adenovirus-Vectored Vaccine against SARS-CoV-2 Infection. Vaccines (Basel) 2021; 9:vaccines9121486. [PMID: 34960232 PMCID: PMC8707922 DOI: 10.3390/vaccines9121486] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/29/2021] [Accepted: 12/13/2021] [Indexed: 11/17/2022] Open
Abstract
We present a case of immune thrombocytopenia (ITP) induced by the chimpanzee adenovirus-vectored vaccine, without evidence of thrombosis, eight days after vaccine administration. The thrombocytopenia condition improved after administering steroid treatment. This adenovirus vaccine had been reported to induce rare side effects, such as immune thrombotic thrombocytopenia. This case report showed that it could also induce immune thrombocytopenia without the presence of thrombosis. Therefore, we should be cautious of this rare side effect as global vaccine administrations against coronavirus disease increase.
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Kim G, Choi EJ, Park HS, Lee JH, Lee JH, Lee KH. A Case Report of Immune Thrombocytopenia after ChAdOx1 nCoV-19 Vaccination. J Korean Med Sci 2021; 36:e306. [PMID: 34751013 PMCID: PMC8575766 DOI: 10.3346/jkms.2021.36.e306] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/20/2021] [Indexed: 11/20/2022] Open
Abstract
Immune thrombocytopenia (ITP) is an autoimmune condition characterized by platelet destruction through antibody-mediated mechanism. ITP is one of the manifestations of a coronavirus disease, as well as an adverse event occurring after vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Several cases of ITP have been described after vaccination with two mRNA-based vaccines-BTN162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna)-against SARS-CoV-2. Herein, we report a case of ITP occurring after vaccination with ChAdOx1 adenovirus vector nCoV-19 (AstraZeneca) vaccine in Korea. A 66-year-old woman presented with multiple ecchymoses on both upper and lower extremities and gingival bleeding, appearing 3 days after receiving the first dose of ChAdOx1 nCoV-19. Her laboratory results showed isolated severe thrombocytopenia without evidence of combined coagulopathy. She was diagnosed with ITP and successfully treated with high-dose dexamethasone and intravenous immunoglobulin. Clinical suspicion to identify vaccine-related ITP is important to promptly initiate appropriate treatment.
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Affiliation(s)
- Gyungah Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun-Ji Choi
- Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Han-Seung Park
- Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung-Hee Lee
- Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Je-Hwan Lee
- Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyoo-Hyung Lee
- Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Chang JC, Hawley HB. Vaccine-Associated Thrombocytopenia and Thrombosis: Venous Endotheliopathy Leading to Venous Combined Micro-Macrothrombosis. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:1163. [PMID: 34833382 PMCID: PMC8621006 DOI: 10.3390/medicina57111163] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 01/08/2023]
Abstract
Serious vaccine-associated side effects are very rare. Major complications of vaccines are thrombocytopenia and thrombosis in which pathogenetic mechanism is consistent with endotheliopathy characterized by "attenuated" sepsis-like syndrome, leading to the activation of inflammatory and microthrombotic pathway. In the COVID-19 pandemic, acute respiratory distress syndrome caused by microthrombosis has been the major clinical phenotype from the viral sepsis in association with endotheliopathy-associated vascular microthrombotic disease (EA-VMTD), sometimes presenting with thrombotic thrombocytopenic purpura (TTP)-like syndrome. Often, venous thromboembolism has coexisted due to additional vascular injury. In contrast, clinical phenotypes of vaccine complication have included "silent" immune thrombocytopenic purpura (ITP-like syndrome), multiorgan inflammatory syndrome, and deep venous thrombosis (DVT), cerebral venous sinus thrombosis (CVST) in particular. These findings are consistent with venous (v) EA-VMTD. In vEA-VMTD promoted by activated complement system following vaccination, "consumptive" thrombocytopenia develops as ITP-like syndrome due to activated unusually large von Willebrand factor (ULVWF) path of hemostasis via microthrombogenesis. Thus, the pathologic phenotype of ITP-like syndrome is venous microthrombosis. Myocarditis/pericarditis and other rare cases of inflammatory organ syndrome are promoted by inflammatory cytokines released from activated inflammatory pathway, leading to various organ endotheliitis. Vaccine-associated CVST is a form of venous combined "micro-macrothrombosis" composed of binary components of "microthrombi strings" from vEA-VMTD and "fibrin meshes" from vaccine-unrelated incidental vascular injury perhaps such as unreported head trauma. This mechanism is identified based on "two-path unifying theory" of in vivo hemostasis. Venous combined micro-macrothrombosis due to vaccine is much more serious thrombosis than isolated distal DVT made of macrothrombus. This paradigm changing novel concept of combined micro-macrothrombosis implies the need of combined therapy of a complement inhibitor and anticoagulant for CVST and other complex forms of DVT.
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Affiliation(s)
- Jae C. Chang
- Department of Medicine, University of California Irvine School of Medicine, Irvine, CA 92868, USA
| | - H. Bradford Hawley
- Department of Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH 45435, USA;
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Kondo M, Yamanaka K. Possible HSP reactivation post-COVID-19 vaccination and booster. Clin Case Rep 2021; 9:e05032. [PMID: 34745629 PMCID: PMC8552090 DOI: 10.1002/ccr3.5032] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 10/01/2021] [Accepted: 10/12/2021] [Indexed: 11/30/2022] Open
Abstract
A 45-year-old woman with a history of Henoch-Schönlein (HSP) purpura received COVID-19 vaccination. The patient showed HSP reactivation after COVID-19 vaccination and booster. In HSP, autoimmune memory of vasculitis persists and might be reactivated with COVID-19 vaccination.
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Affiliation(s)
- Makoto Kondo
- Department of DermatologyMie University Graduate School of MedicineTsuJapan
| | - Keiichi Yamanaka
- Department of DermatologyMie University Graduate School of MedicineTsuJapan
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15
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Behlivani E, Tragiannidis A, Hatzipantelis E, Panagopoulou P. Immune thrombocytopenia secondary to COVID-19 infection: Report of two cases. Pediatr Blood Cancer 2021; 68:e29175. [PMID: 34061445 PMCID: PMC8209819 DOI: 10.1002/pbc.29175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/22/2021] [Accepted: 05/24/2021] [Indexed: 01/16/2023]
Affiliation(s)
- Evangelia Behlivani
- 4th Department of Pediatrics, School of Medicine, Aristotle University of ThessalonikiPapageorgiou General HospitalThessalonikiGreece
| | - Athanasios Tragiannidis
- Children & Adolescent Hematology‐Oncology Unit, 2nd Department of Pediatrics, School of Medicine, Aristotle University of ThessalonikiAHEPA HospitalThessalonikiGreece
| | - Emmanuel Hatzipantelis
- Children & Adolescent Hematology‐Oncology Unit, 2nd Department of Pediatrics, School of Medicine, Aristotle University of ThessalonikiAHEPA HospitalThessalonikiGreece
| | - Paraskevi Panagopoulou
- 4th Department of Pediatrics, School of Medicine, Aristotle University of ThessalonikiPapageorgiou General HospitalThessalonikiGreece
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Collins EC, Carr MJ, Kim JS, Lewis J, Maleque N, Desai K, Chen L, Sevransky J, Gaddh M, Rouphael N, Hubbard J, Pendley AM. Immune thrombocytopenia in 2 healthy young women after the Pfizer-BioNTech BNT16B2b2 messenger RNA coronavirus disease 2019 vaccination. J Am Coll Emerg Physicians Open 2021; 2:e12531. [PMID: 34568869 PMCID: PMC8448486 DOI: 10.1002/emp2.12531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/05/2021] [Accepted: 07/19/2021] [Indexed: 12/02/2022] Open
Abstract
Immune thrombocytopenic purpura (ITP) is a rare complication associated with vaccines targeting various diseases, including influenza, measles-mumps-rubella, hepatitis B, and diphtheria-tetanus-pertussis. We report 2 cases of ITP in healthy 20-year-old and 21-year-old women presenting to Emory University in Atlanta, GA, 2 days after the second dose and 11 days after the first dose (respectively) of the Pfizer-BioNTech messenger RNA severe acute respiratory syndrome coronavirus 2 vaccine. Both patients recovered quickly. With more than a billion doses of coronavirus disease 2019 vaccines safely administered worldwide as of May 2021, discussions with patients should put into perspective the low risks of vaccination against the enormous societal benefit of the coronavirus disease 2019 vaccine.
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Affiliation(s)
- Emilie C. Collins
- Department of Emergency MedicineEmory University School of MedicineAtlantaGeorgia
| | - Michael J. Carr
- Department of Emergency MedicineEmory University School of MedicineAtlantaGeorgia
| | - James Soo Kim
- Department of Internal MedicineDivision of Hospital MedicineEmory University School of MedicineAtlantaGeorgia
| | - John Lewis
- Department of Emergency MedicineEmory University School of MedicineAtlantaGeorgia
| | - Noble Maleque
- Department of Internal MedicineEmory University School of MedicineAtlantaGeorgia
| | - Krisha Desai
- Department of Internal MedicineEmory University School of MedicineAtlantaGeorgia
| | - Lauren Chen
- Department of Internal MedicineEmory University School of MedicineAtlantaGeorgia
| | - Jon Sevransky
- Department of Internal MedicineDivision of HematologyEmory University School of MedicineAtlantaGeorgia
| | - Manila Gaddh
- Department of Internal Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep, Emory Critical Care Center, Emory HealthcareEmory University School of MedicineAtlantaGeorgia
| | - Nadine Rouphael
- Department of Internal MedicineDivision of Infectious DiseaseEmory University School of MedicineAtlantaGeorgia
| | | | - Andrew M. Pendley
- Department of Emergency MedicineEmory University School of MedicineEmory University Nell Hodgson Woodruff School of NursingAtlantaGeorgia
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Oxford-AstraZeneca Coronavirus Disease-2019 Vaccine-Induced Immune Thrombocytopenia on Day Two. Case Rep Hematol 2021; 2021:2580832. [PMID: 34395000 PMCID: PMC8363434 DOI: 10.1155/2021/2580832] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 07/14/2021] [Indexed: 12/05/2022] Open
Abstract
Introduction Vaccines have been one of the most impactful human discoveries that have significantly changed life expectancy. Immune thrombocytopenic purpura (ITP) is an autoimmune disease characterized by platelet damage, life-threatening thrombocytopenia, and haemorrhage when the platelet count reaches below 20 × 109/mcL. Its pathogenesis involves viral mimicry or T-cell-induced immune destruction in antibody-negative cases. The clinical manifestations of thrombocytopenia vary according to the severity (level of platelets) and range from being asymptomatic to severe haemorrhage. ITP is treated with immunosuppression. Case Presentation. A 26-year-old Iraqi male laboratory analyst with an unremarkable medical history presented with severe thrombocytopenia 2 days after receiving the Oxford-AstraZeneca coronavirus disease-2019 vaccine. The patient was asymptomatic with unremarkable examination findings. However, his low platelet count was discovered accidentally, and the patient did not exhibit the resistance pattern of ITP and recovered successfully with regular immunosuppressant treatment. Conclusion Patients with a history of thrombocytopenia can develop vaccine-induced thrombocytopenia earlier than the expected onset. Close monitoring, through regular complete blood counts, is highly recommended for patients with previous thrombocytopenia because the immune modulation process of the vaccine can worsen preexisting thrombocytopenia.
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