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Deprecated: Implicit conversion from float 267.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Haematologica 2021 ; 106 (8): 2170-2179 Nephropedia Template TP
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Antibody-mediated procoagulant platelets in SARS-CoV-2-vaccination associated immune thrombotic thrombocytopenia #MMPMID34011137
Althaus K; Moller P; Uzun G; Singh A; Beck A; Bettag M; Bosmuller H; Guthoff M; Dorn F; Petzold GC; Henkes H; Heyne N; Jumaa H; Kreiser K; Limpach C; Luz B; Maschke M; Muller JA; Munch J; Nagel S; Potzsch B; Muller J; Schlegel C; Viardot A; Bazner H; Wolf M; Pelzl L; Warm V; Willinek WA; Steiner J; Schneiderhan-Marra N; Vollherbst D; Sachs UJ; Fend F; Bakchoul T
Haematologica 2021[Aug]; 106 (8): 2170-2179 PMID34011137show ga
The COVID-19 pandemic has resulted in significant morbidity and mortality worldwide. To prevent severe infection, mass COVID-19 vaccination campaigns with several vaccine types are currently underway. We report pathological and immunological findings in 8 patients who developed vaccine-induced immune thrombotic thrombocytopenia (VITT) after administration of SARS-CoV-2 vaccine ChAdOx1 nCoV-19. We analyzed patient material using enzyme immune assays, flow cytometry and heparin-induced platelet aggregation assay and performed autopsies on two fatal cases. Eight patients (5 female, 3 male) with a median age of 41.5 years (range, 24 to 53) were referred to us with suspected thrombotic complications 6 to 20 days after ChAdOx1 nCoV-19 vaccination. All patients had thrombocytopenia at admission. Patients had a median platelet count of 46.5 x109/L (range, 8 to 92). Three had a fatal outcome and 5 were successfully treated. Autopsies showed arterial and venous thromboses in various organs and the occlusion of glomerular capillaries by hyaline thrombi. Sera from VITT patients contain high titer antibodies against platelet factor 4 (PF4) (OD 2.59+/-0.64). PF4 antibodies in VITT patients induced significant increase in procoagulant markers (P-selectin and phosphatidylserine externalization) compared to healthy volunteers and healthy vaccinated volunteers. The generation of procoagulant platelets was PF4 and heparin dependent. We demonstrate the contribution of antibody-mediated platelet activation in the pathogenesis of VITT.