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接种 ChAdOx1 nCoV-19(Covishield)冠状病毒疫苗后可能出现的疫苗相关免疫性血小板减少症。

Vaccination-associated immune thrombocytopenia possibly due to ChAdOx1 nCoV-19 (Covishield) coronavirus vaccine.

机构信息

Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.

Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

出版信息

BMJ Case Rep. 2022 Mar 30;15(3):e249237. doi: 10.1136/bcr-2022-249237.

Abstract

Immune thrombocytopenia (ITP) is an acquired haemorrhagic diathesis of immune-mediated destruction, impaired production or increased splenic sequestration of platelets. It can be idiopathic (primary) or secondary (infections, medications, HIV infection, malignancies, connective tissue diseases or rarely secondary to vaccination). ITP postvaccination is termed vaccine-associated ITP (VITP) and is known to be caused by vaccines against various infectious agents such as measles-mumps-rubella, , pneumococcus, hepatitis B virus and human papilloma virus. Cases of VITP post SARS-CoV-2 vaccination have also been reported in the literature. Various hypotheses on the occurrence of the same are theorised, but no single theory has been proven to cause VITP conclusively. Management includes routine treatment of ITP with use of agents such as steroids, intravenous immunoglobulins, or on rare occasions a thrombopoietic agent or vinca alkaloids. We present a case of VITP possibly due to ChAdOx1 nCoV-19 (Covishield) vaccination in a middle-aged woman who responded to steroid therapy.

摘要

免疫性血小板减少症 (ITP) 是一种获得性出血性素质,由免疫介导的血小板破坏、产生减少或脾脏对血小板的摄取增加所致。它可以是特发性的(原发性)或继发性的(感染、药物、HIV 感染、恶性肿瘤、结缔组织疾病,或罕见地继发于疫苗接种)。疫苗接种后发生的 ITP 称为疫苗相关 ITP (VITP),已知是由针对各种病原体的疫苗引起的,如麻疹-腮腺炎-风疹、肺炎球菌、乙型肝炎病毒和人乳头瘤病毒。文献中也有报道接种 SARS-CoV-2 疫苗后发生 VITP 的病例。对于同样情况的发生有各种假说,但没有单一的理论被证明可以明确导致 VITP。治疗包括常规使用皮质类固醇、静脉注射免疫球蛋白,或在罕见情况下使用促血小板生成素或长春碱类药物治疗 ITP。我们报告了一例可能由 ChAdOx1 nCoV-19(Covishield)疫苗接种引起的 VITP 病例,该病例发生在一名中年女性中,她对皮质类固醇治疗有反应。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/610e/8969046/47421e9b380d/bcr-2022-249237f01.jpg

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