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The use of IV immunoglobulin in the treatment of vaccine-induced immune thrombotic thrombocytopenia: to the editor

To the editor:The ChAdOx1 nCoV-19 is a recombinant chimpanzee adenoviral vector vaccine encoding the spike glycoprotein of severe acute respiratory syndrome coronavirus 2, which has a good efficacy rate and safety profile.1 Over the past 2 months, concern has been raised over reported thrombotic eve...

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Main Authors: Uzun, Günalp (Author) , Althaus, Karina (Author) , Singh, Anurag (Author) , Möller, Peter (Author) , Ziemann, Ulf (Author) , Mengel, Annerose (Author) , Rosenberger, Peter (Author) , Guthoff, Martina (Author) , Petzold, Gabor C. (Author) , Müller, Jens (Author) , Büchsel, Martin (Author) , Feil, Katharina (Author) , Henkes, Hans (Author) , Heyne, Nils (Author) , Maschke, Matthias (Author) , Limpach, Caroline (Author) , Nagel, Simon (Author) , Sachs, Ulrich Jörg Hein (Author) , Fend, Falko (Author) , Bakchoul, Tamam (Author)
Format: Article (Journal) Editorial
Language:English
Published: 24 June 2021
In: Blood
Year: 2021, Volume: 138, Issue: 11, Pages: 992-996
ISSN:1528-0020
DOI:10.1182/blood.2021012479
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1182/blood.2021012479
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Author Notes:Günalp Uzun, Karina Althaus, Anurag Singh, Peter Möller, Ulf Ziemann, Annerose Mengel, Peter Rosenberger, Martina Guthoff, Gabor C. Petzold, Jens Müller, Martin Büchsel, Katharina Feil, Hans Henkes, Nils Heyne, Matthias Maschke, Caroline Limpach, Simon Nagel, Ulrich J. Sachs, Falko Fend and Tamam Bakchoul
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Summary:To the editor:The ChAdOx1 nCoV-19 is a recombinant chimpanzee adenoviral vector vaccine encoding the spike glycoprotein of severe acute respiratory syndrome coronavirus 2, which has a good efficacy rate and safety profile.1 Over the past 2 months, concern has been raised over reported thrombotic events associated with thrombocytopenia after ChAdOx1 nCoV-19 vaccination, a complication called vaccine-induced immune thrombotic thrombocytopenia (VITT).2-6 The pathophysiology of VITT is still unclear but seems to be similar to spontaneous autoimmune heparin-induced thrombocytopenia (aHIT).2,7 In fact, as in aHIT, VITT patients develop platelet factor-4 (PF4) antibodies without any recent exposure to heparin. These antibodies are able to activate platelets and induce procoagulant platelet phenotype via crosslinking the Fc γ receptor IIA on platelet surface. IV immunoglobulin (IVIG) has been successfully used in the treatment of spontaneous aHIT.8,9 We and others have recently shown that IVIG inhibits the in vitro induction of procoagulant platelet phenotype by sera from VITT patients.2,7 Herein, we report our clinical experience on the use of IVIG in the management of VITT and present novel laboratory analysis of the effect of IVIG therapy on anti-PF4 antibody level and platelet activation in VITT patients.
Item Description:Prepublished online on Blood First Edition 24 June 2021
Gesehen am 22.03.2022
Physical Description:Online Resource
ISSN:1528-0020
DOI:10.1182/blood.2021012479

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