Tidsskr Nor Laegeforen. 2021 Apr 29;141. doi: 10.4045/tidsskr.21.0312. Print 2021 Apr 30.
New vaccines against COVID-19 are being rolled out globally. AstraZeneca's vaccine ChAdOx1 nCoV-19 was not known to cause vaccine-induced immune thrombotic thrombocytopenia (VITT) at the time of this case.
The patient was a previously healthy woman in her thirties with headaches that developed one week after vaccination with ChAdOx1 nCoV-19. Three days later, her condition deteriorated rapidly, and she presented to the emergency department with slurred speech, uncoordinated movements and reduced consciousness. Symptoms progressed to left-sided hemiparesis and her level of consciousness deteriorated. Computed tomography (CT) of the head showed a large right-sided haemorrhage and incipient herniation. She was found to have severe thrombocytopenia 37 x 109/l, (ref 145 - 390 x 109/l). In spite of efforts to reduce intracranial pressure, the patient died the following day. Post mortem examination revealed antibodies to PF4, and fresh small thrombi were found in the transverse sinus, frontal lobe and pulmonary artery.
Severe thrombocytopenia and antibodies to PF4 make a diagnosis of vaccine-induced immune thrombotic thrombocytopenia (VITT) likely.
全球正在推出针对 COVID-19 的新疫苗。阿斯利康的 ChAdOx1 nCoV-19 疫苗在本例发生时，尚不清楚会引起疫苗诱导的免疫性血栓性血小板减少症（VITT）。
患者为一名三十多岁的既往健康女性，在接种 ChAdOx1 nCoV-19 疫苗一周后出现头痛。三天后，病情迅速恶化，出现言语不清、运动不协调和意识降低，被送往急诊室。症状进展为左侧偏瘫，意识水平下降。头部 CT 显示右侧大出血和开始出现脑疝。发现患者血小板严重减少 37×109/L（参考范围 145-390×109/L）。尽管努力降低颅内压，患者次日死亡。尸检发现 PF4 抗体，横窦、额叶和肺动脉内发现新鲜小血栓。
严重血小板减少和 PF4 抗体使疫苗诱导的免疫性血栓性血小板减少症（VITT）的诊断可能性较大。
