Khuhapinant Archrob, Rungjirajittranon Tarinee, Suwanawiboon Bundarika, Chinthammitr Yingyong, Ruchutrakool Theera
Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand.
Thromb J. 2021 Sep 8;19(1):65. doi: 10.1186/s12959-021-00317-3.
Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare but fatal complication of the Coronavirus Disease 2019 vaccine. The many reports of VITT have mostly been in the Caucasian population. Here, we present the first reported case in an Asian population.
A 26-year-old female had severe headache and severe thrombocytopenia 8 days after administration of the ChAdOx1 nCoV-19 vaccine developed by AstraZeneca. Although no thrombosis was demonstrated by imaging studies, she had very highly elevated d-dimer levels during hospitalization. Serology for antibodies against platelet factor 4 was positive on several days with very high optical density readings. We found that the antibody could induce spontaneous platelet aggregation without the presence of heparin. We decided to treat her with intravenous immunoglobulin, high-dose dexamethasone, and a prophylactic dose of apixaban. She improved rapidly and was discharged from the hospital 6 days after admission. Neither thrombocytopenia nor thrombosis was subsequently detected at the three-week follow-up.
Despite the lower rate of thrombosis, VITT can occur in the Asian population. Early detection and prompt treatment of VITT can improve the patient's clinical outcome. Thromboprophylaxis with nonheparin anticoagulants also prevents clot formation.
疫苗诱导的免疫性血栓性血小板减少症（VITT）是2019冠状病毒病疫苗一种罕见但致命的并发症。许多关于VITT的报告大多来自白种人群体。在此，我们报告亚洲人群中的首例病例。
一名26岁女性在接种阿斯利康公司研发的ChAdOx1 nCoV-19疫苗8天后出现严重头痛和严重血小板减少症。尽管影像学检查未显示血栓形成，但她住院期间D-二聚体水平极高。针对血小板因子4抗体的血清学检测在数天呈阳性，光密度读数非常高。我们发现该抗体在无肝素存在的情况下可诱导血小板自发聚集。我们决定用静脉注射免疫球蛋白、高剂量地塞米松和预防剂量的阿哌沙班对她进行治疗。她恢复迅速，入院6天后出院。在三周的随访中未再检测到血小板减少症或血栓形成。
尽管血栓形成率较低，但VITT可发生在亚洲人群中。VITT的早期检测和及时治疗可改善患者的临床结局。使用非肝素抗凝剂进行血栓预防也可防止血栓形成。
