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腺病毒载体新冠病毒疫苗(ChAdOx1 nCoV-19)接种后老年患者发生的疫苗诱导免疫性血栓性血小板减少症:迷你综述和病例报告。

Vaccine-induced immune thrombotic thrombocytopenia after ChAdOx1 nCoV-19 vaccine in an older patient: Minireview and a case report.

机构信息

Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, SP, Brazil; Department of Neurology Surgery, São Francisco University Medical Hospital, Bragança Paulista, SP, Brazil.

Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, SP, Brazil.

出版信息

J Infect Public Health. 2022 Jun;15(6):638-642. doi: 10.1016/j.jiph.2022.04.008. Epub 2022 Apr 25.

Abstract

Rare cases of unusual thrombosis and thrombocytopenia after administration of the ChAdOx1 nCoV-19 vaccine (AstraZeneca) have been reported. The unusual symptoms are called vaccine-induced immune thrombotic thrombocytopenia (VITT). In the present study, a brief background about cases of unusual thrombosis and thrombocytopenia after administration of the ChAdOx1 nCoV-19 was provided. In addition, a description of a case of a 66-year-old woman who had received this vaccine and developed VITT was done. She presented to the hospital complaining of hematomas in the right upper limb 14 days after the ChAdOx1 nCoV-19 vaccine, without a history of trauma (Glasgow coma scale of 14) and thrombocytopenia even though signs of thrombosis were absent. Cranium computed tomography scan indicated intraparenchymal hematoma and cerebral thrombosis, besides anastomotic Labbé vein thrombosis. The woman received platelets transfusion, dexamethasone, and neuroprotection measures, but even so, on the twelfth postoperative day, she died of cerebral rebleeding. In conclusion, it is crucial to point out the immuno-hypersensitivity mechanisms associated with ChAdOx1 nCoV-19 vaccine reactions, helping to reduce their occurrences and reinforcing confidence in vaccine administration.

摘要

已报道在接种 ChAdOx1 nCoV-19(阿斯利康)疫苗后出现罕见的异常血栓形成和血小板减少病例。这些异常症状被称为疫苗诱导的免疫性血栓性血小板减少症(VITT)。在本研究中,简要介绍了接种 ChAdOx1 nCoV-19 后发生异常血栓形成和血小板减少的病例。此外,还描述了一例 66 岁女性接种该疫苗后发生 VITT 的病例。该患者在接种 ChAdOx1 nCoV-19 后 14 天因右上臂血肿就诊,无外伤史(格拉斯哥昏迷量表评分为 14 分)和血小板减少,尽管没有血栓形成的迹象。头颅计算机断层扫描显示脑实质血肿和脑内血栓形成,以及吻合口 Labbe 静脉血栓形成。该患者接受了血小板输注、地塞米松和神经保护措施,但即便如此,在术后第 12 天,她还是因脑再出血而死亡。总之,必须指出与 ChAdOx1 nCoV-19 疫苗反应相关的免疫超敏反应机制,这有助于减少其发生,并增强对疫苗接种的信心。

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