ภาวะเกล็ดเลือดต่ำที่กระตุ้นการเกิดหลอดเลือดอุดตันจากภูมิคุ้มกัน ภายหลังได้รับวัคซีน

Kochawan Boonyawat; Pichika Chantrathammachart; Pimjai Niparuk; Teeraya Puavilai; Suporn Chancharunee; Pantep Angchaisuksiri

Authors

Kochawan Boonyawat -
Pichika Chantrathammachart Division of Hematology, Department of Medicine, Ramathibodi Hospital
Pimjai Niparuk Division of Hematology, Department of Medicine, Ramathibodi Hospital
Teeraya Puavilai Division of Hematology, Department of Medicine, Ramathibodi Hospital
Suporn Chancharunee Division of Hematology, Department of Medicine, Ramathibodi Hospital
Pantep Angchaisuksiri Division of Hematology, Department of Medicine, Ramathibodi Hospital

Keywords:

ChAdOx1 nCoV-19 vaccine, Thrombocytopenia, Venous thrombosis, Coronavirus 2019

Abstract

Vaccine-induced thrombotic thrombocytopenia (VITT) is an important complication following vaccination
with the ChAdOx1 nCoV-19 vaccine. Common presentations include venous or arterial thrombosis accompanied
by thrombocytopenia and elevated D-dimer levels. Antiplatelet factor 4/polyanionic antibodies are frequently
detected exhibiting high optical density values. VITT is also associated with high mortality when diagnosis
and treatment are delayed. We report a case of a 31-year-old man who presented with severe headache and
backache for 8 days following ChAdOx1 nCoV-19 vaccination. Spontaneous ecchymosis was also noted. CT
scan revealed acute cerebral venous 2 portal vein thrombosis. His platelet count was low. D-dimer level was
markedly elevated and anti-PF4/polyanionic antibodies were detected. A diagnosis of VITT was made. The
patient received IVIG, high dose corticosteroid and anticoagulant. His symptoms resolved. His platelet count
and D-dimer level were back to normal. He received anticoagulant therapy for 6 months.

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References

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Guidance produced by the Expert Haematology Panel (EHP) focussed on Vaccine induced Thrombosis and Thrombocytopenia (VITT) 2021 [Available from: https://b-s-h.org.uk/about-us/news/guidance-produced-by-the-expert-haematology-panel-ehp-focussed-on-vaccine-induced-thrombosis-and-thrombocytopenia-vitt/.