Severe thrombocytopenia, thrombosis and anti-PF4 antibody after Pfizer-BioNTech COVID-19 mRNA vaccine booster-Is it vaccine-induced Immune thrombotic thrombocytopenia?

Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a serious and life-threatening complication occurring after adenovirus-vector COVID-19 vaccines, and is rarely reported after other vaccine types. Herein, we report a case of possible VITT after the Pfizer-BioNTech mRNA vaccine booster, wh...

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Main Authors: Ling, Victor W. T., Fan, Eugene Bingwen, Lau, Soon Lee, Lee, Xiu Hue, Tan, Chuen Wen, Lee, Shir Ying
Other Authors: Lee Kong Chian School of Medicine (LKCMedicine)
Format: Article
Language:English
Published: 2023
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Online Access:https://hdl.handle.net/10356/169481
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spelling sg-ntu-dr.10356-1694812023-07-23T15:38:12Z Severe thrombocytopenia, thrombosis and anti-PF4 antibody after Pfizer-BioNTech COVID-19 mRNA vaccine booster-Is it vaccine-induced Immune thrombotic thrombocytopenia? Ling, Victor W. T. Fan, Eugene Bingwen Lau, Soon Lee Lee, Xiu Hue Tan, Chuen Wen Lee, Shir Ying Lee Kong Chian School of Medicine (LKCMedicine) Science::Medicine Thrombocytopenia COVID-19 Vaccine Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a serious and life-threatening complication occurring after adenovirus-vector COVID-19 vaccines, and is rarely reported after other vaccine types. Herein, we report a case of possible VITT after the Pfizer-BioNTech mRNA vaccine booster, who presented with extensive lower limb deep vein thrombosis, severe thrombocytopenia, markedly elevated D-dimer and positive anti-PF4 antibody occurring 2 weeks post-vaccination, concurrent with a lupus anticoagulant. A complete recovery was made after intravenous immunoglobulin, prednisolone and anticoagulation with the oral direct Xa inhibitor rivaroxaban. The presenting features of VITT may overlap with those of antiphospholipid syndrome associated with anti-PF4 and immune thrombocytopenia. We discuss the diagnostic considerations in VITT and highlight the challenges of performing VITT confirmatory assays in non-specialized settings. The set of five diagnostic criteria for VITT is a useful tool for guiding initial management, but may potentially include patients without VITT. The bleeding risks of severe thrombocytopenia in the face of thrombosis, requiring anticoagulant therapy, present a clinical challenge, but early recognition and management can potentially lead to favorable outcomes. Published version 2023-07-20T03:04:34Z 2023-07-20T03:04:34Z 2022 Journal Article Ling, V. W. T., Fan, E. B., Lau, S. L., Lee, X. H., Tan, C. W. & Lee, S. Y. (2022). Severe thrombocytopenia, thrombosis and anti-PF4 antibody after Pfizer-BioNTech COVID-19 mRNA vaccine booster-Is it vaccine-induced Immune thrombotic thrombocytopenia?. Vaccines, 10(12), 2023-. https://dx.doi.org/10.3390/vaccines10122023 2076-393X https://hdl.handle.net/10356/169481 10.3390/vaccines10122023 36560433 2-s2.0-85144727508 12 10 2023 en Vaccines © 2022 by the Authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). application/pdf
institution Nanyang Technological University
building NTU Library
continent Asia
country Singapore
Singapore
content_provider NTU Library
collection DR-NTU
language English
topic Science::Medicine
Thrombocytopenia
COVID-19 Vaccine
spellingShingle Science::Medicine
Thrombocytopenia
COVID-19 Vaccine
Ling, Victor W. T.
Fan, Eugene Bingwen
Lau, Soon Lee
Lee, Xiu Hue
Tan, Chuen Wen
Lee, Shir Ying
Severe thrombocytopenia, thrombosis and anti-PF4 antibody after Pfizer-BioNTech COVID-19 mRNA vaccine booster-Is it vaccine-induced Immune thrombotic thrombocytopenia?
description Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a serious and life-threatening complication occurring after adenovirus-vector COVID-19 vaccines, and is rarely reported after other vaccine types. Herein, we report a case of possible VITT after the Pfizer-BioNTech mRNA vaccine booster, who presented with extensive lower limb deep vein thrombosis, severe thrombocytopenia, markedly elevated D-dimer and positive anti-PF4 antibody occurring 2 weeks post-vaccination, concurrent with a lupus anticoagulant. A complete recovery was made after intravenous immunoglobulin, prednisolone and anticoagulation with the oral direct Xa inhibitor rivaroxaban. The presenting features of VITT may overlap with those of antiphospholipid syndrome associated with anti-PF4 and immune thrombocytopenia. We discuss the diagnostic considerations in VITT and highlight the challenges of performing VITT confirmatory assays in non-specialized settings. The set of five diagnostic criteria for VITT is a useful tool for guiding initial management, but may potentially include patients without VITT. The bleeding risks of severe thrombocytopenia in the face of thrombosis, requiring anticoagulant therapy, present a clinical challenge, but early recognition and management can potentially lead to favorable outcomes.
author2 Lee Kong Chian School of Medicine (LKCMedicine)
author_facet Lee Kong Chian School of Medicine (LKCMedicine)
Ling, Victor W. T.
Fan, Eugene Bingwen
Lau, Soon Lee
Lee, Xiu Hue
Tan, Chuen Wen
Lee, Shir Ying
format Article
author Ling, Victor W. T.
Fan, Eugene Bingwen
Lau, Soon Lee
Lee, Xiu Hue
Tan, Chuen Wen
Lee, Shir Ying
author_sort Ling, Victor W. T.
title Severe thrombocytopenia, thrombosis and anti-PF4 antibody after Pfizer-BioNTech COVID-19 mRNA vaccine booster-Is it vaccine-induced Immune thrombotic thrombocytopenia?
title_short Severe thrombocytopenia, thrombosis and anti-PF4 antibody after Pfizer-BioNTech COVID-19 mRNA vaccine booster-Is it vaccine-induced Immune thrombotic thrombocytopenia?
title_full Severe thrombocytopenia, thrombosis and anti-PF4 antibody after Pfizer-BioNTech COVID-19 mRNA vaccine booster-Is it vaccine-induced Immune thrombotic thrombocytopenia?
title_fullStr Severe thrombocytopenia, thrombosis and anti-PF4 antibody after Pfizer-BioNTech COVID-19 mRNA vaccine booster-Is it vaccine-induced Immune thrombotic thrombocytopenia?
title_full_unstemmed Severe thrombocytopenia, thrombosis and anti-PF4 antibody after Pfizer-BioNTech COVID-19 mRNA vaccine booster-Is it vaccine-induced Immune thrombotic thrombocytopenia?
title_sort severe thrombocytopenia, thrombosis and anti-pf4 antibody after pfizer-biontech covid-19 mrna vaccine booster-is it vaccine-induced immune thrombotic thrombocytopenia?
publishDate 2023
url https://hdl.handle.net/10356/169481
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