A case of thrombocytopenia and multiple thromboses after vaccination with ChAdOx1 nCoV-19 against SARS-CoV-2
Open Access
- 17 June 2021
- journal article
- research article
- Published by American Society of Hematology in Blood Advances
- Vol. 5 (12), 2569-2574
- https://doi.org/10.1182/bloodadvances.2021004904
Abstract
Recently, reports of severe thromboses, thrombocytopenia, and hemorrhage in persons vaccinated with the chimpanzee adenovirus-vectored vaccine (ChAdOx1 nCoV-19, AZD1222, Vaxzevria; Oxford/AstraZeneca) against severe acute respiratory syndrome coronavirus 2 have emerged. We describe an otherwise healthy 30-year-old woman who developed thrombocytopenia, ecchymosis, portal vein thrombosis, and cerebral venous sinus thrombosis the second week after she received the ChAdOx1 nCoV-19 vaccine. Extensive diagnostic workup for thrombosis predispositions showed heterozygosity for the prothrombin mutation, but no evidence of myeloproliferative neoplasia or infectious or autoimmune diseases. Her only temporary risk factor was long-term use of oral contraceptive pills (OCPs). Although both the prothrombin mutation and use of OCPs predispose to portal and cerebral vein thrombosis, the occurrence of multiple thromboses within a short time and the associated pattern of thrombocytopenia and consumption coagulopathy are highly unusual. A maximum 4T heparin-induced thrombocytopenia (HIT) score and a positive immunoassay for anti-platelet factor 4/heparin antibodies identified autoimmune HIT as a potential pathogenic mechanism. Although causality has not been established, our case emphasizes the importance of clinical awareness. Further studies of this potentially new clinical entity have suggested that it should be regarded as a vaccine-induced immune thrombotic thrombocytopenia.This publication has 26 references indexed in Scilit:
- Spontaneous heparin-induced thrombocytopenia syndrome without any proximate heparin exposure, infection, or inflammatory condition: Atypical clinical features with heparin-dependent platelet activating antibodiesPlatelets, 2014
- Spontaneous heparin-induced thrombocytopenia syndrome: 2 new cases and a proposal for defining this disorderBlood, 2014
- Risk of venous thromboembolism and myocardial infarction associated with factor V Leiden and prothrombin mutations and blood typeCMAJ : Canadian Medical Association Journal, 2013
- Immune globulins and thrombotic adverse events as recorded in a large administrative database in 2008 through 2010Transfusion, 2012
- Hormonal contraception and risk of venous thromboembolism: national follow-up studyBMJ, 2009
- Heparin‐induced thrombocytopenia (HIT) during postoperative warfarin thromboprophylaxis: a second example of postorthopedic surgery ‘spontaneous’ HITJournal of Thrombosis and Haemostasis, 2009
- A Spontaneous Prothrombotic Disorder Resembling Heparin-induced ThrombocytopeniaThe American Journal of Medicine, 2008
- Evaluation of pretest clinical score (4 T's) for the diagnosis of heparin‐induced thrombocytopenia in two clinical settingsJournal of Thrombosis and Haemostasis, 2006
- Incidence and clinical significance of anti‐PF4/heparin antibodies of the IgG, IgM, and IgA class in 755 consecutive patient samples referred for diagnostic testing for heparin‐induced thrombocytopeniaEuropean Journal of Haematology, 2006
- The mechanism of heparin‐induced platelet aggregationEuropean Journal of Haematology, 1989