Please use this identifier to cite or link to this item: https://doi.org/10.3390/vaccines10122023
Title: Severe Thrombocytopenia, Thrombosis and Anti-PF4 Antibody after Pfizer-BioNTech COVID-19 mRNA Vaccine Booster—Is It Vaccine-Induced Immune Thrombotic Thrombocytopenia?
Authors: Lee, Shir Ying 
Ling, Victor WT
Fan, Bingwen Eugene
Lau, Soon Lee
Lee, Xiu Hue
Tan, Chuen Wen 
Keywords: COVID-19 vaccine
VITT
thrombocytopenia
thrombosis
anti-PF4 antibody
lupus anticoagulant
Issue Date: 26-Nov-2022
Publisher: Multidisciplinary Digital Publishing Institute (MDPI)
Citation: Lee, Shir Ying, Ling, Victor WT, Fan, Bingwen Eugene, Lau, Soon Lee, Lee, Xiu Hue, Tan, Chuen Wen (2022-11-26). Severe Thrombocytopenia, Thrombosis and Anti-PF4 Antibody after Pfizer-BioNTech COVID-19 mRNA Vaccine Booster—Is It Vaccine-Induced Immune Thrombotic Thrombocytopenia?. Vaccines 10 (12). ScholarBank@NUS Repository. https://doi.org/10.3390/vaccines10122023
Abstract: Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a serious and life-threatening complication occurring after adenovirus-vector COVID-19 vaccines, and is rarely reported after other vaccine types. Herein, we report a case of possible VITT after the Pfizer-BioNTech mRNA vaccine booster, who presented with extensive lower limb deep vein thrombosis, severe thrombocytopenia, markedly elevated D-dimer and positive anti-PF4 antibody occurring 2 weeks post-vaccination, concurrent with a lupus anticoagulant. A complete recovery was made after intravenous immunoglobulin, prednisolone and anticoagulation with the oral direct Xa inhibitor rivaroxaban. The presenting features of VITT may overlap with those of antiphospholipid syndrome associated with anti-PF4 and immune thrombocytopenia. We discuss the diagnostic considerations in VITT and highlight the challenges of performing VITT confirmatory assays in non-specialized settings. The set of five diagnostic criteria for VITT is a useful tool for guiding initial management, but may potentially include patients without VITT. The bleeding risks of severe thrombocytopenia in the face of thrombosis, requiring anticoagulant therapy, present a clinical challenge, but early recognition and management can potentially lead to favorable outcomes.
Source Title: Vaccines
URI: https://scholarbank.nus.edu.sg/handle/10635/234996
ISSN: 2076-393X
DOI: 10.3390/vaccines10122023
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