Adjunct Immune Globulin for Vaccine-Induced Thrombotic Thrombocytopenia.

Jun 10, 2021

Contributor: Alex Bourguignon,Donald M Arnold,Theodore E Warkentin,James W Smith,Tania Pannu,Jeffrey M Shrum,Zainab A A Al Maqrashi,Anjali Shroff,Marie-Claude Lessard,Normand Blais,John G Kelton,Ishac Nazy

Adjunct Immune Globulin for Vaccine-Induced Thrombotic Thrombocytopenia.

The use of high-dose intravenous immune globulin (IVIG) plus anticoagulation is recommended for the treatment of vaccine-induced immune thrombotic thrombocytopenia (VITT), a rare side effect of adenoviral vector vaccines against coronavirus disease 2019 (Covid-19). We describe the response to IVIG therapy in three of the first patients in whom VITT was identified in Canada after the receipt of the ChAdOx1 nCoV-19 vaccine. The patients were between the ages of 63 and 72 years; one was female. At the time of this report, Canada had restricted the use of the ChAdOx1 nCoV-19 vaccine to persons who were 55 years of age or older on the basis of reports that VITT had occurred primarily in younger persons. Two of the patients in our study presented with limb-artery thrombosis; the third had cerebral venous and arterial thrombosis. Variable patterns of serum-induced platelet activation were observed in response to heparin and platelet factor 4 (PF4), indicating the heterogeneity of the manifestations of VITT in serum. After the initiation of IVIG, reduced antibody-induced platelet activation in serum was seen in all three patients. (Funded by the Canadian Institutes of Health Research.).
Copyright © 2021 Massachusetts Medical Society.

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About The Expert

Alex Bourguignon

From the Departments of Medicine (A.B., D.M.A., T.E.W., J.W.S., Z.A.A.A.M., A.S., J.G.K., I.N.) and Pathology and Molecular Medicine (A.B., T.E.W.), Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, the Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB (T.P., J.M.S.), the Department of Hematology/Oncology, Centre Hospitalier de l’Université de Montreal, Montreal (N.B.), and the Department of Hematology/Oncology, Hôpital Régional de Saint-Jérôme, St. Jerome, QC (M.-C.L.) – all in Canada.

Donald M Arnold

From the Departments of Medicine (A.B., D.M.A., T.E.W., J.W.S., Z.A.A.A.M., A.S., J.G.K., I.N.) and Pathology and Molecular Medicine (A.B., T.E.W.), Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, the Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB (T.P., J.M.S.), the Department of Hematology/Oncology, Centre Hospitalier de l’Université de Montreal, Montreal (N.B.), and the Department of Hematology/Oncology, Hôpital Régional de Saint-Jérôme, St. Jerome, QC (M.-C.L.) – all in Canada.

Theodore E Warkentin

From the Departments of Medicine (A.B., D.M.A., T.E.W., J.W.S., Z.A.A.A.M., A.S., J.G.K., I.N.) and Pathology and Molecular Medicine (A.B., T.E.W.), Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, the Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB (T.P., J.M.S.), the Department of Hematology/Oncology, Centre Hospitalier de l’Université de Montreal, Montreal (N.B.), and the Department of Hematology/Oncology, Hôpital Régional de Saint-Jérôme, St. Jerome, QC (M.-C.L.) – all in Canada.

James W Smith

From the Departments of Medicine (A.B., D.M.A., T.E.W., J.W.S., Z.A.A.A.M., A.S., J.G.K., I.N.) and Pathology and Molecular Medicine (A.B., T.E.W.), Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, the Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB (T.P., J.M.S.), the Department of Hematology/Oncology, Centre Hospitalier de l’Université de Montreal, Montreal (N.B.), and the Department of Hematology/Oncology, Hôpital Régional de Saint-Jérôme, St. Jerome, QC (M.-C.L.) – all in Canada.

Tania Pannu

From the Departments of Medicine (A.B., D.M.A., T.E.W., J.W.S., Z.A.A.A.M., A.S., J.G.K., I.N.) and Pathology and Molecular Medicine (A.B., T.E.W.), Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, the Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB (T.P., J.M.S.), the Department of Hematology/Oncology, Centre Hospitalier de l’Université de Montreal, Montreal (N.B.), and the Department of Hematology/Oncology, Hôpital Régional de Saint-Jérôme, St. Jerome, QC (M.-C.L.) – all in Canada.

Jeffrey M Shrum

From the Departments of Medicine (A.B., D.M.A., T.E.W., J.W.S., Z.A.A.A.M., A.S., J.G.K., I.N.) and Pathology and Molecular Medicine (A.B., T.E.W.), Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, the Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB (T.P., J.M.S.), the Department of Hematology/Oncology, Centre Hospitalier de l’Université de Montreal, Montreal (N.B.), and the Department of Hematology/Oncology, Hôpital Régional de Saint-Jérôme, St. Jerome, QC (M.-C.L.) – all in Canada.

Zainab A A Al Maqrashi

From the Departments of Medicine (A.B., D.M.A., T.E.W., J.W.S., Z.A.A.A.M., A.S., J.G.K., I.N.) and Pathology and Molecular Medicine (A.B., T.E.W.), Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, the Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB (T.P., J.M.S.), the Department of Hematology/Oncology, Centre Hospitalier de l’Université de Montreal, Montreal (N.B.), and the Department of Hematology/Oncology, Hôpital Régional de Saint-Jérôme, St. Jerome, QC (M.-C.L.) – all in Canada.

Anjali Shroff

From the Departments of Medicine (A.B., D.M.A., T.E.W., J.W.S., Z.A.A.A.M., A.S., J.G.K., I.N.) and Pathology and Molecular Medicine (A.B., T.E.W.), Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, the Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB (T.P., J.M.S.), the Department of Hematology/Oncology, Centre Hospitalier de l’Université de Montreal, Montreal (N.B.), and the Department of Hematology/Oncology, Hôpital Régional de Saint-Jérôme, St. Jerome, QC (M.-C.L.) – all in Canada.

Marie-Claude Lessard

From the Departments of Medicine (A.B., D.M.A., T.E.W., J.W.S., Z.A.A.A.M., A.S., J.G.K., I.N.) and Pathology and Molecular Medicine (A.B., T.E.W.), Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, the Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB (T.P., J.M.S.), the Department of Hematology/Oncology, Centre Hospitalier de l’Université de Montreal, Montreal (N.B.), and the Department of Hematology/Oncology, Hôpital Régional de Saint-Jérôme, St. Jerome, QC (M.-C.L.) – all in Canada.

Normand Blais

From the Departments of Medicine (A.B., D.M.A., T.E.W., J.W.S., Z.A.A.A.M., A.S., J.G.K., I.N.) and Pathology and Molecular Medicine (A.B., T.E.W.), Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, the Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB (T.P., J.M.S.), the Department of Hematology/Oncology, Centre Hospitalier de l’Université de Montreal, Montreal (N.B.), and the Department of Hematology/Oncology, Hôpital Régional de Saint-Jérôme, St. Jerome, QC (M.-C.L.) – all in Canada.

John G Kelton

From the Departments of Medicine (A.B., D.M.A., T.E.W., J.W.S., Z.A.A.A.M., A.S., J.G.K., I.N.) and Pathology and Molecular Medicine (A.B., T.E.W.), Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, the Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB (T.P., J.M.S.), the Department of Hematology/Oncology, Centre Hospitalier de l’Université de Montreal, Montreal (N.B.), and the Department of Hematology/Oncology, Hôpital Régional de Saint-Jérôme, St. Jerome, QC (M.-C.L.) – all in Canada.

Ishac Nazy

From the Departments of Medicine (A.B., D.M.A., T.E.W., J.W.S., Z.A.A.A.M., A.S., J.G.K., I.N.) and Pathology and Molecular Medicine (A.B., T.E.W.), Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, the Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB (T.P., J.M.S.), the Department of Hematology/Oncology, Centre Hospitalier de l’Université de Montreal, Montreal (N.B.), and the Department of Hematology/Oncology, Hôpital Régional de Saint-Jérôme, St. Jerome, QC (M.-C.L.) – all in Canada.

References

PubMed