Immune-Mediated Thrombotic Thrombocytopenic Purpura Following mRNA-Based COVID-19 Vaccine BNT162b2: Case Report and Mini-Review of the Literature

被引:3
作者
Buetler, Vanessa Alexandra [1 ]
Agbariah, Nada [2 ]
Schild, Deborah Pia [3 ]
Liechti, Fabian D. [4 ]
Wieland, Anna [2 ]
Andina, Nicola [2 ]
Hammann, Felix [1 ]
Kremer Hovinga, Johanna A. [2 ]
机构
[1] Univ Bern, Bern Univ Hosp, Dept Gen Internal Med, Clin Pharmacol & Toxicol, Bern, Switzerland
[2] Univ Bern, Bern Univ Hosp, Dept Hematol, Cent Hematol Lab, Bern, Switzerland
[3] Univ Bern, Bern Univ Hosp, Dept Cardiol, Bern, Switzerland
[4] Univ Bern, Bern Univ Hosp, Dept Gen Internal Med, Bern, Switzerland
基金
瑞士国家科学基金会;
关键词
purpura; thrombotic thrombocytopenic; ADAMTS13; mRNA SARS-CoV-2 vaccine; COVID-19; vaccine; MICROANGIOPATHIES; PATHOPHYSIOLOGY; ANTIBODIES; REGISTRY; ADULTS;
D O I
10.3389/fmed.2022.890661
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
IntroductionAn increasing number of case reports have associated vaccinations against coronavirus disease 2019 (COVID-19) with immune-mediated thrombotic thrombocytopenic purpura (iTTP), a very rare but potentially life-threatening thrombotic microangiopathy, which leads to ischemic organ dysfunction. Thrombus formation in iTTP is related to a severe deficiency of the specific von Willebrand-factor-cleaving protease ADAMTS13 due to ADAMTS13 autoantibodies. MethodsWe present a case of iTTP following exposure to the mRNA-based COVID-19 vaccine BNT162b2 (Comirnaty (R), Pfizer-BioNTech). In addition, we review previously reported cases in the literature and assess current evidence. ResultsApart from our case, twenty cases of iTTP occurring after COVID-19 vaccination had been published until the end of November 2021. There were 11 male and 10 female cases; their median age at diagnosis was 50 years (range 14-84 years). Five patients (24%) had a preexisting history of iTTP. Recombinant adenoviral vector-based vaccines were involved in 19%, mRNA-based vaccines in 81%. The median onset of symptoms after vaccination was 12 days (range 5-37), with 20 cases presenting within 30 days. Treatment included therapeutic plasma exchange in all patients. Additional rituximab, caplacizumab, or both these treatments were given in 43% (9/21), 14% (3/21), and 24% (5/21) of cases, respectively. One patient died, despite a prolonged clinical course in one patient, all surviving patients were in clinical remission at the end of the observational period. ConclusionClinical features of iTTP following COVID-19 vaccination were in line with those of pre-pandemic iTTP. When timely initiated, an excellent response to standard treatment was seen in all cases. ADAMTS13 activity should be determined pre-vaccination in patients with a history of a previous iTTP episode. None of the reported cases met the WHO criteria for assessing an adverse event following immunization (AEFI) as a consistent causal association to immunization. Further surveillance of safety data and additional case-based assessment are needed.
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