Acquired Thrombotic Thrombocytopenic Purpura: A Rare Coincidence after COVID-19 mRNA Vaccine?

Tso, Allison Ching Yee; Ong, Kiat Hoe; Sum, Christina Lai Lin; Fan, Bingwen Eugene; Chan, Gabriel; Christopher, Dheepa; Howe, Hwee Siew; Lai, Yi Wye; Lim, Xin Rong; Leung, Bernard P.

doi:10.1055/s-0042-1744301

Cited by 8 publications

(3 citation statements)

References 9 publications

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“…A total of 84 cases of TMA associated with COVID‐19 vaccination were found in 58 articles, 2,9–65 including 64 patients diagnosed with TTP (Table 1), 17 cases manifested as aHUS (Table 2, cases 1–17), and three patients presented as unclassified TMA (Table 2, cases 18–20). Subsequently, relevant clinical records were extracted for analysis, including baseline characteristics, laboratory tests, treatment options, and outcomes.…”

Section: Clinical Characteristics Of Tma Patients Associated With Cov...mentioning

confidence: 99%

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New‐onset and relapsed thrombotic microangiopathy post‐COVID‐19 vaccination

2023

Journal of Medical Virology

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Thrombotic microangiopathy (TMA) associated with coronavirus disease 2019 (COVID-19) vaccination has been reported, however, the clinical characteristics and pathogenesis remained mysterious. We reviewed 84 TMA cases post-COVID-19 vaccination, including 64 patients diagnosed with thrombotic thrombocytopenic purpura (TTP), 17 cases presented as atypical hemolytic uremic syndrome (aHUS), and three cases manifested as unclassified TMA. TMA episodes were mostly associated with messenger RNA vaccines. For TTP, 67.6% of females developed symptoms after the first dose of the vaccine, and 63.0% of males were secondary to the second dose (p = 0.015). Compared with TTP, aHUS generally appeared within 7 days (p = 0.002) and showed higher levels of serum creatinine (p < 0.001). 87.5% of TTP received plasma exchange (PEX)-based treatment, and 52.9% of aHUS adopted non-PEX-based therapies (p < 0.001). Mechanistically, complement dysfunction, neutrophil activation, and the generation of pathogenic autoantibodies resulting from molecular mimicry contribute to explaining the pathogenesis of TMA post-COVID-19 vaccination.

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Section: Clinical Characteristics Of Tma Patients Associated With Cov...mentioning

confidence: 99%

“…There were 64 affected individuals presented as TTP (Table 1), 2,9–49 including 44 newly diagnosed (68.8%) and 20 relapsed (31.3%). The median age was 49.5 (14–84) years.…”

Section: Clinical Characteristics Of Tma Patients Associated With Cov...mentioning

confidence: 99%

New‐onset and relapsed thrombotic microangiopathy post‐COVID‐19 vaccination

2023

Journal of Medical Virology

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“…10,11 Protecting iTTP patients with anti-SARS-COV-2 vaccination is therefore recommended (https://www.hematology. org/covid-19/covid-19-and-ttp), although de novo and relapsed cases of iTTP occurring after anti-SARS-CoV-2 vaccination have been described as well, [12][13][14][15][16][17] raising the question of a causative relationship. [18][19][20] In this context, little or no information is available on whether a hypercoagulable status may occur in iTTP patients after receiving anti-SARS-CoV-2 vaccine and what is the serological response profile, which can be impaired by immunosuppressive treatment.…”

Section: Introductionmentioning

confidence: 99%

Hemostatic Profile and Serological Response of Patients with Immune Thrombotic Thrombocytopenic Purpura after Receiving BNT162b2 Vaccine: A Prospective Study

et al. 2023

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Introduction Coronavirus disease is a clinical challenge for patients with autoimmune conditions. Patients affected by immune thrombotic thrombocytopenic purpura (iTTP) are particularly vulnerable to SARS-CoV-2 infection. Protecting these patients with vaccination is therefore mandatory, although concerns may exist on a possible increased thrombotic risk or risk of disease relapse after vaccine exposure. So far, there is no information on serological response and hemostatic activation in iTTP patients after SARS-CoV-2 vaccination. Materials and Methods In this study, in April 2021, we enrolled iTTP patients in clinical remission and on regular outpatient follow-up to receive the first and second dose BNT162b2 vaccine as a part of a prospective trial aimed at monitoring for 6 months after vaccination the occurrence of subclinical laboratory signs of clotting activation, as well as overt thrombotic complications or disease relapse. The seroconversion response was monitored in parallel. The results were compared with those of control non-iTTP subjects. Results A moderate decrease of ADAMTS-13 activity was recorded at 3 and 6 months in five patients with normal values at baseline, while an ADAMTS-13 relapse occurred at 6 months in one patient. Abnormalities in the endothelium activation biomarkers postvaccination were observed in iTTP patients compared with controls. The immunological response to vaccine was overall positive. No clinical iTTP relapses or thrombotic events manifested in the 6 month-follow-up after vaccination. Conclusion The results of this study are in favor of efficacy and safety of mRNA vaccines in patients with iTTP, and highlight the importance of long-term monitoring of iTTP patients.

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