J Korean Med Sci.  2022 Mar;37(10):e75. 10.3346/jkms.2022.37.e75.

A Case Report of Thrombotic Thrombocytopenia After ChAdOx1 nCov-19 Vaccination and Heparin Use During Hemodialysis

• Son YB
• Kim TB
• Min HJ
• Lee J
• Yang J
• Kim MG
• Jo SK
• Cho WY
• Oh SW

• KMID: 2526981
• DOI: http://doi.org/10.3346/jkms.2022.37.e75

Abstract

Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare but life-threatening complication. VITT strongly mimics heparin-induced thrombocytopenia (HIT) and shares clinical features. Heparin is commonly used to prevent coagulation during hemodialysis. Therefore, nephrologists might encounter patients needing dialysis with a history of heparin exposure who developed thrombotic thrombocytopenia after vaccination. A 70-year-old male presented with acute kidney injury and altered mental status due to lithium intoxication. He needed consecutive hemodialysis using heparin. Deep vein thrombosis of left lower extremity and accompanying severe thrombocytopenia of 15,000/µL on 24 days after vaccination and at the same time, nine days after heparin use. Anti-platelet factor 4 antibody test was positive. Anticoagulation with apixaban and intravenous immunoglobulin (IVIG) infusion resolved swelling of his left calf and thrombocytopenia. There were no definitive diagnostic tools capable of differentiating between VITT and HIT in this patient. Although VITT and HIT share treatment with IVIG and non-heparin anticoagulation, distinguishing between VITT and HIT will make it possible to establish a follow-up vaccination plan in a person who has had a thrombocytopenic thrombotic event. Further research is needed to develop the tools to make a clear distinction between the clinical syndromes.

Keyword

Anti-Platelet Factor 4 Antibody; ChAdOx1 COVID-19 Vaccine; Heparin; Thrombotic Thrombocytopenia

Figure

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  Fig. 1 Serial PLT counts are presented in order to clinical events. A 70-year-old man who had thrombotic thrombocytopenia was complicated by deep vein thrombosis of lower extremity after vaccination. After administration of intravenous immunoglobulin with dose of 1 g/kg for 2 consecutive days, the PLT count gradually rose to 104,000/µL.PLT = platelet, IVIG = intravenous immunoglobulin.

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