Ntelis Spyridon, Champ Kathryn
Internal Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, USA.
J Community Hosp Intern Med Perspect. 2022 Jul 4;12(4):80-84. doi: 10.55729/2000-9666.1073. eCollection 2022.
Thrombotic thrombocytopenic purpura (TTP) is a rare disease characterized by thrombocytopenia, microangiopathic hemolytic anemia, and ischemic organ damage. Several cases of TTP associated with administration of COVID-19 vaccines have been reported. We report a case of a 63-year-old woman with a past medical history of hypertension, diabetes mellitus, chronic kidney disease, HIV infection, and remote history of TTP who presented with several days of shortness of breath on exertion, chest tightness, low-grade fever, and bruising thirty-three days after receiving the second dose of the mRNA-1273 COVID-19 vaccine. Thrombocytopenia and hemolytic anemia with schistocytes were noted on testing, and ADAMTS13 activity was <5%. Temporizing treatment with fresh frozen plasma was started immediately on presentation, and treatment was continued with daily therapeutic plasma exchange and corticosteroids. TTP should be considered in patients who present with thrombocytopenia after COVID-19 vaccination, especially if there is a past history of TTP.
血栓性血小板减少性紫癜（TTP）是一种罕见疾病，其特征为血小板减少、微血管病性溶血性贫血和缺血性器官损伤。已有多例与接种新冠病毒疫苗相关的TTP病例报告。我们报告一例63岁女性，既往有高血压、糖尿病、慢性肾脏病、HIV感染病史，曾患TTP，在接种第二剂mRNA-1273新冠病毒疫苗33天后出现劳力性气短、胸闷、低热和瘀斑数天。检查发现血小板减少和伴有裂体细胞的溶血性贫血，ADAMTS13活性<5%。就诊时立即开始用新鲜冰冻血浆进行临时治疗，并继续每日进行治疗性血浆置换和使用糖皮质激素。对于新冠病毒疫苗接种后出现血小板减少的患者，尤其是既往有TTP病史的患者，应考虑TTP的诊断。
