Department of Nephrology, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China.
Department of Hepatic Surgery, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
BMC Nephrol. 2022 Dec 13;23(1):400. doi: 10.1186/s12882-022-03034-9.
Thrombotic thrombocytopenic purpura (TTP) is a rare and life-threatening thrombotic microangiopathy characterized by microangiopathic hemolytic anemia, severe thrombocytopenia, and organ ischemia. It is related to severe deficiency in ADAMTS13, which is usually acquired via ADAMTS13 autoantibodies or inherited via mutations of the ADAMTS13 gene. The etiology of acquired TTP including HIV infection, pregnancy, autoimmune disease, organ transplantation, drugs, malignancy and so on. Here, we firstly reported a patient diagnosed as acquired TTP after pegylated interferon therapy for hepatitis B and COVID-19 vaccination.
A 36-year-old male attended to our unit with a five-day history of intermittent hematuria and progressive fatigue on January 5th, 2022. He had a 13 years history of hepatitis B infection and undergone pegylated interferon treatment (which was paused for two months because of COVID-19 vaccination) for nearly 3 years. Laboratory evaluation revealed a haemoglobin level of 61 g/L, platelet count of 11 × 10/L, lactate dehydrogenase 2133 U/L. The direct and indirect Coombs test were both negative. On a peripheral blood smear, there were about 18.8% schistocytes. Meanwhile, the results of ADAMTS 13 activity and antibody were < 5% and 181.34 ng/ml (131.25-646.5), respectively CONCLUSION: This case firstly reported the rare complication of TTP after pegylated interferon treatment for hepatitis B and COVID-19 vaccine injection. This unique sign warrants more attention as an early cue of diagnosis of TTP and be aware of the rarity adverse effect of interferon therapy and COVID-19 vaccination.
血栓性血小板减少性紫癜（TTP）是一种罕见的、危及生命的血栓性微血管病，其特征为微血管性溶血性贫血、严重血小板减少和器官缺血。它与 ADAMTS13 的严重缺乏有关，通常通过 ADAMTS13 自身抗体获得，或通过 ADAMTS13 基因突变遗传。获得性 TTP 的病因包括 HIV 感染、妊娠、自身免疫性疾病、器官移植、药物、恶性肿瘤等。在这里，我们首次报道了一例在乙型肝炎的聚乙二醇干扰素治疗和 COVID-19 疫苗接种后诊断为获得性 TTP 的患者。
一名 36 岁男性于 2022 年 1 月 5 日因间歇性血尿和进行性疲劳就诊，病史 5 天。他有 13 年乙型肝炎感染史，近 3 年接受聚乙二醇干扰素治疗（因 COVID-19 疫苗接种暂停 2 个月）。实验室评估显示血红蛋白水平为 61g/L，血小板计数为 11×10/L，乳酸脱氢酶 2133 U/L。直接和间接 Coombs 试验均为阴性。在外周血涂片上，约有 18.8%的裂片细胞。同时，ADAMTS 13 活性和抗体的检测结果分别为 <5%和 181.34ng/ml（131.25-646.5）。
本病例首次报道了乙型肝炎的聚乙二醇干扰素治疗和 COVID-19 疫苗接种后 TTP 的罕见并发症。这种独特的表现需要更多的关注，作为 TTP 诊断的早期线索，并意识到干扰素治疗和 COVID-19 疫苗接种的罕见不良反应。
