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COVID-19 Testing

Potential Pathology Behind AstraZeneca COVID-19 Vaccination and Blood Clots

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BACKGROUND AND PURPOSE:

  • Schultz et al. (NEJM, 2021) describes 5 cases of severe thrombosis and thrombocytopenia following vaccination with the ChAdOx1 (AstraZeneca) COVID-19 vaccine

METHODS:

  • Case reports
  • Setting
    • Oslo University Hospital, Norway
  • Cases included
    • 5 healthcare workers
    • 32 to 54 years old
  • Study design
    • Serum antibodies tested (ELISA)
      • Platelet factor 4 (PF4)-polyanion complexes
      • SARS-CoV-2 spike and nucleocapsid proteins

RESULTS:

  • 4 patients had severe cerebral venous thrombosis with intracranial hemorrhage | Fatal in 3 patients
  • At time of admission
    • Levels of D-dimer were elevated in all patients
    • Screening for thrombophilia with proteins C and S and antithrombin was negative
  • Platelet immunologic testing
    • All five patients had high levels of IgG antibodies to PF4–polyanion complexes
    • Platelets in serum from Patients 1, 3, 4, and 5 were clearly activated in the absence of added heparin
  • All patients were negative for SARS-CoV-2 antibodies, suggesting previous infection was unlikely

CONCLUSION:

  • 5 individuals developed severe venous thromboembolism in unusual sites and concomitant thrombocytopenia 7 to 10 days after vaccination (AstraZeneca)
  • All 5 patients had a high level of antibodies to PF4–polyanion complexes
  • The authors suggest

…that these cases represent a vaccine-related variant of spontaneous heparin-induced thrombocytopenia that we refer to as vaccine-induced immune thrombotic thrombocytopenia (VITT)

Learn More – Primary Sources:

Thrombosis and Thrombocytopenia after ChAdOx1 nCoV-19 Vaccination

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Related ObG Topics:

Safety and Efficacy of AstraZeneca Oxford’s COVID-19 Vaccine
Guidance on COVID-19 Vaccine Including Pregnancy
An Update on COVID-19 Vaccine Related Anaphylaxis: Cases Remain Rare
How Common are Anaphylaxis and Allergic Reactions Following Pfizer-BioNTech COVID-19 Vaccination?

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