Long-term persistence of high anti-PF4 antibodies titer in a challenging case of AZD1222 vaccine-induced thrombotic thrombocytopenia

Submitted: 19 March 2023
Accepted: 1 June 2023
Published: 28 June 2023
Abstract Views: 330
PDF: 127
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Authors

  • Luca Barcella https://orcid.org/0000-0002-4576-0914 Immunohematology and Transfusion Medicine and Thrombosis and Hemostasis Center, Papa Giovanni XXIII Hospital, Bergamo, Italy.
  • Chiara Ambaglio https://orcid.org/0000-0002-3005-0346 Immunohematology and Transfusion Medicine and Thrombosis and Hemostasis Center, Papa Giovanni XXIII Hospital, Bergamo, Italy.
  • Paolo Gritti Intensive Care Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy.
  • Francesca Schieppati https://orcid.org/0000-0003-0338-2000 Immunohematology and Transfusion Medicine and Thrombosis and Hemostasis Center, Papa Giovanni XXIII Hospital, Bergamo, Italy.
  • Varusca Brusegan Immunohematology and Transfusion Medicine and Thrombosis and Hemostasis Center, Papa Giovanni XXIII Hospital, Bergamo, Italy.
  • Eleonora Sanga Immunohematology and Transfusion Medicine and Thrombosis and Hemostasis Center, Papa Giovanni XXIII Hospital, Bergamo, Italy.
  • Marina Marchetti https://orcid.org/0000-0001-9036-960X Immunohematology and Transfusion Medicine and Thrombosis and Hemostasis Center, Papa Giovanni XXIII Hospital, Bergamo; School of Medicine and Surgery, University of Milan Bicocca, Milan, Italy.
  • Luca Lorini Intensive Care Unit, Papa Giovanni XXIII Hospital, Bergamo; School of Medicine and Surgery, University of Milan Bicocca, Milan, Italy.
  • Anna Falanga annafalanga@yahoo.com https://orcid.org/0000-0002-5007-3457 Immunohematology and Transfusion Medicine and Thrombosis and Hemostasis Center, Papa Giovanni XXIII Hospital, Bergamo; School of Medicine and Surgery, University of Milan Bicocca, Milan, Italy.

A syndrome occurring after adenoviral vector anti-SARS-CoV-2 vaccination, characterized by thrombocytopenia, venous thrombosis, and circulating anti-PF4 antibodies, known as vaccine-induced immune thrombotic thrombocytopenia (VITT), is well described. Data on the long-term course of this syndrome are lacking. Our aim is to report the clinical and laboratory features of a patient with VITT from diagnosis and during 21 months of follow-up. Cerebral venous thrombosis associated with elevated D-dimer, low fibrinogen, thrombocytopenia, and anti-PF4 antibodies positivity occurred in this patient after ChAdOx1 nCoV-19 vaccination. Cerebral thrombosis required a revascularization procedure and decompressive craniectomy. Upon dexamethasone and anticoagulant treatment initiation, the platelet count recovered. However, a persistently high anti-PF4 antibody titer, without thrombosis recurrence, was observed. Little is known about the long-term persistence of anti-PF4 antibodies, their clinical significance, and their possible role in guiding therapeutic decisions. In our patient, we decided to continue anticoagulant treatment beyond 21 months with parallel anti-PF4 antibody monitoring.

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How to Cite

Barcella, L., Ambaglio, C., Gritti, P., Schieppati, F., Brusegan, V., Sanga, E., … Falanga, A. (2023). Long-term persistence of high anti-PF4 antibodies titer in a challenging case of AZD1222 vaccine-induced thrombotic thrombocytopenia. Bleeding, Thrombosis and Vascular Biology, 2(2). https://doi.org/10.4081/btvb.2023.72