We describe the first Danish case of presumed inflammatory and thrombotic response to vaccination with an adenoviral (ChAdOx1) vector‐based COVID‐19 vaccine (AZD1222). The case describes a 60‐year‐old woman who was admitted with intractable abdominal pain 7 days after receiving the vaccine. Computed tomography of the abdomen revealed bilateral adrenal hemorrhages. On the following day, she developed a massive right‐sided ischemic stroke and magnetic resonance imaging angiography showed occlusion of the right internal carotid artery. The ischemic area was deemed too large to offer reperfusion therapy. During admission, blood tests showed a remarkable drop in platelet counts from 118,000 to 5000 per μl and a substantial increase in D‐dimer. The patient died on the sixth day of hospitalization. Blood tests revealed platelet factor 4 reactive antibodies, imitating what is seen in heparin‐induced thrombocytopenia. This may be a novel immune‐mediated response to the vaccine.

Abstract. Hvas A-M, Nexo E (Aarhus University Hospital, Aarhus C, Denmark). Holotrancobalamina first choice assay for diagnosing early vitamin B 12 deficiency. J Intern Med 2005; 257: 289-298.Objectives. The performance of holotransco balamin (holoTC) was compared with the other markers of vitamin B 12 deficiency, and the influence of age, renal function, and thyroid status was examined. Design and interventions. We examined 937 individuals not treated with vitamin B 12 but in whom vitamin B 12 deficiency was suspected because of a plasma methylmalonic acid (MMA) above 0.28 lmol L )1 within the past 4 years. Besides laboratory tests, a structured interview and a neurological examination were performed amongst 534 individuals. Amongst these, 140 individuals qualified for a randomized trial (MMA 0.40-2.00 lmol L )1 ). They were randomized to injections with vitamin B 12 or placebo and re-examined after 3 months.Setting. One university hospital in Aarhus, Denmark. Results. The ROC curves indicate that holoTC (AUC: 0.90) compared favourable with plasma vitamin B 12 (AUC: 0.85) for identifying individuals likely to have vitamin B 12 deficiency (MMA ‡0.75 lmol L )1 and plasma total homocysteine (tHcy) ‡15 lmol L )1 ), and further that holoTC (AUC: 0.91) might replace combined testing with plasma vitamin B 12 and the metabolites. No association was observed between the biochemical markers and symptoms and signs possibly related to vitamin B 12 deficiency. HoloTC, TC saturation, plasma vitamin B 12 , MMA, and tHcy were significantly associated with plasma creatinine (all with P < 0.001). Only tHcy was significantly associated with thyroid stimulating hormone (P ¼ 0.02). Conclusions. HoloTC shows promise as first-line tests for diagnosing early vitamin B 12 deficiency.

The characteristic changes occurring in haematological indices during pregnancy and postpartum are described in this study. The results may be used as reference values in the assessment of health status of pregnant women with a similar socio-economic and racial background.

To cite this article: Grove EL, Hvas AM, Mortensen SB, Larsen SB, Kristensen SD. Effect of platelet turnover on whole blood platelet aggregation in patients with coronary artery disease. J Thromb Haemost 2011; 9: 185-91. Summary.Background: Previous studies have demonstrated considerable variation in the antiplatelet effect of aspirin. Objectives: To investigate the impact of platelet turnover on the antiplatelet effect of aspirin in patients with stable coronary artery disease (CAD) and to identify determinants of platelet turnover. Methods: Platelet turnover was evaluated by measurements of immature platelets and thrombopoietin in 177 stable CAD patients on aspirin monotherapy, including 85 type 2 diabetics and 92 non-diabetics. Whole blood platelet aggregation was determined using the VerifyNow Ò Aspirin test and multiple electrode aggregometry (MEA, Multiplate , P = 0.034). In a multivariate regression analysis, immature platelet levels were determined by thrombopoietin levels (P < 0.001), smoking (P = 0.020) and type 2 diabetes (P = 0.042). Conclusions: The antiplatelet effect of aspirin was reduced in CAD patients with an increased platelet turnover. Once-daily dosing of aspirin might not suffice to adequately inhibit platelet aggregation in patients with an increased platelet turnover.

Neonatal sepsis is a major cause of morbidity and mortality. Early diagnosis and treatment of the neonate with suspected sepsis are essential to prevent life-threatening complications. Diagnosis of neonatal sepsis is a challenge due to non-specific clinical signs and the fact that infection markers are difficult to interpret in the first and critical phase of neonatal sepsis. The objective of the present study was to systematically evaluate existing evidence of the diagnostic utility of biomarkers for prediction of sepsis in neonates. We conducted a systematic literature search performed in PubMed and Embase. The study population was neonates with gestation age > 24 weeks in their first 28 days of life with suspected sepsis. The included manuscripts were rated due to criteria from a modified rating scale developed by Douglas Altman. Of 292 potentially relevant manuscripts, 77 fulfilled the inclusion and exclusion criteria; 16 (21%) were rated as high-quality studies. C-reactive protein (CRP) was the most extensively studied biomarker evaluated. The high-quality studies indicated that the acute phase protein serum amyloid A had high sensitivity, both at onset of symptoms and 2 days after. The studies evaluating serum amyloid A presented a variable positive predictive value (PPV, 0.67 and 0.92) with a high negative predictive value (NPV, 0.97 and 1.00). The existing evidence of the diagnostic value of serum amyloid A for neonatal sepsis showed promising results, and should be further investigated in clinical settings.