Fatal vaccine-induced immune thrombotic thrombocytopenia (VITT) post Ad26.COV2.S: first documented case outside US.
Fatal vaccine-induced immune thrombotic thrombocytopenia (VITT) post Ad26.COV2.S: first documented case outside US.
复制标题
DOI：
10.1007/s15010-021-01712-8
复制
发表时间：
2022-04
期刊：
影响因子：
7.5
通讯作者：
Cliquennois M
中科院分区：
文献类型：
--
作者：
Rodriguez EVC;Bouazza FZ;Dauby N;Mullier F;d'Otreppe S;Jissendi Tchofo P;Bartiaux M;Sirjacques C;Roman A;Hermans C;Cliquennois M
我们报告了美国以外第一例Ad 26. COV 2. S（Janssen，约翰逊和约翰逊）疫苗诱导的免疫性血小板减少症（VITT）病例。无任何病史的CA年轻女性在疫苗注射后第10天出现深静脉血栓形成和血小板减少症。患者在第一家医疗机构接受低分子量肝素治疗。Ad26.COV2.S疫苗接种后12天，患者因神经功能恶化和右侧偏瘫在我院住院。使用MRI的医学成像显示矢状上级窦主要前部血栓形成，伴有双侧脑实质内出血并发症。通过快速侧流免疫测定法和化学发光技术对血小板因子4（PF 4）-肝素抗体进行的筛查试验均为阴性。使用肝素诱导的多电极聚集测定法进行的血小板活化试验证实了最初的临床假设。尽管立即给予静脉注射免疫球蛋白、地塞米松、达那肝素治疗，并尝试神经外科手术，但患者仍向脑死亡发展。尽管这是一种非常罕见的疫苗接种并发症，但对于在过去30天内接受过基于腺病毒载体的SARS-CoV-2疫苗的患者，如果持续主诉与VITT相符或发生血小板减少相关的血栓栓塞事件，医生应高度怀疑VITT。如果快速抗PF 4免疫学或化学发光技术检测结果为阴性，则不应排除诊断。早期静脉注射免疫球蛋白和非肝素抗凝剂治疗是必要的，因为延误诊断和给予适当的治疗与预后不良有关。
We reported the first described post Ad26.COV2.S (Janssen, Johnson & Johnson) vaccine-induced immune thrombocytopenia (VITT) case outside US. CA young woman without any medical history presented association of deep vein thrombosis and thrombocytopenia at day 10 after vaccine injection. The patient was treated with low-molecular weight heparin at a first medical institution. Twelve days post Ad26.COV2.S vaccination, the patient was admitted at our hospital for neurological deterioration and right hemiplegia. Medical imaging using MRI showed thrombosis of the major anterior part of the sagittal superior sinus with bilateral intraparenchymal hemorrhagic complications. Screening tests for antibodies against platelet factor 4 (PF4)–heparin by rapid lateral flow immunoassay and chemiluminescence techniques were negative. Platelet activation test using heparin-induced multiple electrode aggregometry confirmed the initial clinical hypothesis. Despite immediate treatment with intravenous immunoglobulin, dexamethasone, danaparoid and attempted neurosurgery the patient evolved toward brain death. Even though it is an extremely rare complication of vaccination physicians should maintain a high index of suspicion of VITT in patients who received an adenovirus-vector-based SARS-CoV-2 vaccine within the last 30 days with persistent complains compatible with VITT or thromboembolic event associated with thrombocytopenia. The diagnosis should not be excluded if the rapid anti-PF4 immunological nor chemiluminescence techniques yield negative results. An adapted functional assay should be performed to confirm the diagnosis. Early treatment with intravenous immunoglobulin and non-heparin anticoagulants is essential as delayed diagnosis and administration of appropriate treatment is associated with poor prognosis.
登录
查看更多内容
影响因子：
6.1
作者：
McCrae, Keith R
通讯作者：
McCrae, Keith R
影响因子：
10.4
作者：
Morel-Kopp, M. -C.;Mullier, F.;Ward, C. M.
通讯作者：
Ward, C. M.
影响因子：
10.4
作者：
Platton, Sean;Bartlett, Andrew;Pavord, Sue
通讯作者：
Pavord, Sue
影响因子：
120.7
作者：
See, Isaac;Su, John R.;Broder, Karen R.
通讯作者：
Broder, Karen R.
DOI：
10.1056/nejmoa2101544
发表时间：
2021-06-10
期刊：
The New England journal of medicine
影响因子：
--
作者：
Sadoff J;Gray G;Vandebosch A;Cárdenas V;Shukarev G;Grinsztejn B;Goepfert PA;Truyers C;Fennema H;Spiessens B;Offergeld K;Scheper G;Taylor KL;Robb ML;Treanor J;Barouch DH;Stoddard J;Ryser MF;Marovich MA;Neuzil KM;Corey L;Cauwenberghs N;Tanner T;Hardt K;Ruiz-Guiñazú J;Le Gars M;Schuitemaker H;Van Hoof J;Struyf F;Douoguih M;ENSEMBLE Study Group
通讯作者：
ENSEMBLE Study Group