Immune-mediated thrombotic thrombocytopenic purpura following administration of Pfizer-BioNTech COVID-19 vaccine

Abstract

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Emerging Concepts in Immune Thrombotic Thrombocytopenic Purpura

“…Globally, during the last 50 years only a few cases of TTP have been documented for influenza vaccines (Table 3) (139), even though 3100 million seasonal influenza vaccine doses have been administered in the United States of America alone since 1980 (140). A similar remark can be made of COVID vaccines, where, at the time of writing, only 2 cases of relapsing iTTP (134,135) and 8 de novo iTTP cases (136)(137)(138)141) were identified, among many millions of doses administered currently in the world. In this context, it is important not to confuse iTTP with vaccineinduced thrombotic thrombocytopenia (VITT), which has different mechanisms compared to iTTP (142,143).…”

Thrombotic thrombocytopenic purpura (TTP) after COVID-19 vaccination: A systematic review of reported cases

“…These were usually seen with vaccines against viral agents and within two weeks of vaccination [34] . Furthermore, there is robust evidence of the generation of autoantibodies by the vaccine itself or their adjuvant components resulting in cross-reactivity with or without aberrant stimulation of the immune system leading to the development of auto-immune diseases [21] , [23] . Despite having an adequate insight into these immune mechanisms, it has been more intricate to monitor these with COVID-19 vaccines, given their emergent need that led to their expedited manufacturing [23] .…”

Thrombosis post-mRNA-based SARS-CoV-2 vaccination (BNT162b2) – Time to think beyond thrombosis with thrombocytopenia syndrome (TTS)

“…There are 16 cases of ITP, 12 cases of TTP reactivation, 11 cases of suspected intracerebral hemorrhage (ICH), 6 cases of cerebral venous sinus thrombosis, 1 case of pulmonary embolism, 1 case of renal thrombotic microangiopathy, a case of ST-elevation myocardial infarction (STEMI), 1 case of stroke, 1 case of central retinal artery occlusion, and a case of lower limb DVT associated with BNT162b2( Fig. 1 ) [ [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] ]. The STEMI reported in an elderly gentleman with multiple cardiovascular and pro-thrombotic risk factors 30mins post first dose of BNT162b2 is attributed to vaccination-induced “Kounis syndrome” or allergic myocardial infarction likely secondary to mast cell activation from an allergic or anaphylactoid reaction [ 11 ].…”