Thrombotic Thrombocytopenic Purpura after Ad26.COV2-S Vaccination

Abstract

The U.S. Food and Drug Administration (FDA) recently issued an Emergency Use Authorization (EUA) for two highly effective Sars-CoV-2 (COVID-19) vaccines from Pfizer-BioNTech and Moderna. More recently, Emergency Use Authorization was granted for the Johnson and Johnson COVID-19 vaccine which uses traditional virus-based. In this vaccine, researchers added the gene for the coronavirus spike protein to modified Adenovirus 26 and named it Ad26.COV2-S. Nearly 7 million doses of the Ad26.COV2-S have been administered as of mid-April 2021. Recently the Federal Drug Administration and Center for Disease Control and Prevention reviewed data involving six reported cases in the United States of cerebral venous sinus thrombosis in combination with thrombocytopenia in people who received the vaccination. All cases were in women between 18 and 48, with symptoms developing six to 13 days after vaccination. A recent study in the United Kingdom reported similar events in 23 patients age 21 to 77, 61% of which were female with cases of presumed vaccine induced thrombosis and thrombocytopenia occurring six to 24 days after vaccination. We report a 62-year-old female who presented to the ED with acute onset of altered mental status. She had received the Ad26.COV2-S vaccine 37 days prior to ED presentation. She developed thrombotic thrombocytopenic purpura (TTP) and no other cause was found. To our knowledge this is the first case in the United States of thrombotic thrombocytopenic purpura after receiving the Ad26.COV2-S COVID-19 vaccine.

Thrombotic thrombocytopenic purpura: a new menace after COVID bnt162b2 vaccine

“…Yocum [9] and Sissa [10] reported women with co-morbidities in a similar age group as our patient presenting with similar symptoms within a month of administration of the Ad26.COV2.S and BNT162b2 mRNA vaccines, respectively, indicating the presence of a possible diagnosis of VIPIT that was treated efficiently with plasmapheresis in both cases. Of note, in the latter case involving BNT162b2, the patient suffered from relapse precisely six days after the second dosage of COVID vaccine, just as in our casealthough our patient never had TTP before.…”

First report of a de novo iTTP episode associated with an mRNA‐based anti‐COVID‐19 vaccination

“…has recently been published. 17 The pathophysiology of vaccine-related thrombotic microangiopathies is not entirely clear. Already in 1960, Frick et al reported a TTP episode 24 h after typhoid vaccination, suggesting vaccination as triggering factor.…”

MEDTEC Students against Coronavirus: Investigating the Role of Hemostatic Genes in the Predisposition to COVID-19 Severity

“…Based on these observations, the vWF/ADAMTS13 imbalance has been proposed to be causally related both to the prothrombotic tendency and to the microvascular pulmonary thrombosis, which subtend to a form of thrombotic microangiopathy (TMA) observed in severe COVID-19 patients. The severe deficiency of ADAMTS13 has also gained attention due to the development of a rare TMA, called immune-mediated thrombotic thrombocytopenic purpura [71,72], caused by the production of anti-ADAMTS13 antibodies, in a limited number of subjects after COVID-19 vaccination. Interestingly, vWF significantly increases with age and in non-0 blood type individuals [73], both risk factors for COVID-19.…”