A case of thrombocytopenia and multiple thromboses after vaccination with ChAdOx1 nCoV-19 against SARS-CoV-2.

Abstract

Recently, reports of severe thromboses, thrombocytopenia, and hemorrhage in persons vaccinated with the chimpanzee adenovirus-vectored vaccine (ChAdOx1 nCoV-19, AZD1222, Vaxzevria; Oxford/AstraZeneca) against severe acute respiratory syndrome coronavirus 2 have emerged. We describe an otherwise healthy 30-year-old woman who developed thrombocytopenia, ecchymosis, portal vein thrombosis, and cerebral venous sinus thrombosis the second week after she received the ChAdOx1 nCoV-19 vaccine. Extensive diagnostic workup for thrombosis predispositions showed heterozygosity for the prothrombin mutation, but no evidence of myeloproliferative neoplasia or infectious or autoimmune diseases. Her only temporary risk factor was long-term use of oral contraceptive pills (OCPs). Although both the prothrombin mutation and use of OCPs predispose to portal and cerebral vein thrombosis, the occurrence of multiple thromboses within a short time and the associated pattern of thrombocytopenia and consumption coagulopathy are highly unusual. A maximum 4T heparin-induced thrombocytopenia (HIT) score and a positive immunoassay for anti-platelet factor 4/heparin antibodies identified autoimmune HIT as a potential pathogenic mechanism. Although causality has not been established, our case emphasizes the importance of clinical awareness. Further studies of this potentially new clinical entity have suggested that it should be regarded as a vaccine-induced immune thrombotic thrombocytopenia.

• Authors: Anne Louise Tølbøll Sørensen, Magalie Rolland, Jacob Hartmann, Zitta Barrella Harboe, Casper Roed, Tomas Ø Jensen, Lilian Kolte, Daniel El Fassi, Jens Hillingsø, Aneta Radziwon-Balicka, Robert Sebastian Soyka, Klaus Hansen, Nikolai Kirkby, Jens P Goetze, Mikkel Gybel-Brask, Eva Birgitte Leinøe, Anne-Mette Hvas, Peter Kampmann, Jakob Stensballe
• Journal: Blood advances (Blood Adv) Vol. 5 Issue 12 Pg. 2569-2574 (Jun 22 2021) ISSN: 2473-9537 [Electronic] United States
• PMID: 34137813 (Publication Type: Case Reports, Journal Article)
• Copyright: © 2021 by The American Society of Hematology.

Chemical References

• COVID-19 Vaccines
• ChAdOx1 nCoV-19

Topics

• Adult
• COVID-19
• COVID-19 Vaccines
• ChAdOx1 nCoV-19
• Female
• Humans
• SARS-CoV-2
• Thrombocytopenia (chemically induced)
• Thrombosis (etiology)
• Vaccination