scholarly journals Complicated Long Term Vaccine Induced Thrombotic Immune Thrombocytopenia—A Case Report

Vaccines ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1344
Author(s):  
Albrecht Günther ◽  
Dirk Brämer ◽  
Mathias W. Pletz ◽  
Thomas Kamradt ◽  
Sabine Baumgart ◽  
...  
Keyword(s):  
Intracranial Hemorrhage ◽  
Sinus Thrombosis ◽  
Immunosuppressive Treatment ◽  
Bleeding Risk ◽  
Term Therapy ◽  
Repeated Treatment ◽  
Laboratory Findings ◽  
Platelet Factor ◽  
Sagittal Sinus

Background and Objectives: Vaccine induced thrombotic thrombocytopenia (VITT) may occur after COVID-19 vaccination with recombinant adenoviral vector-based vaccines. VITT can present as cerebral sinus and venous thrombosis (CSVT), often complicated by intracranial hemorrhage. Today it is unclear, how long symptomatic VITT can persist. Here, we report the complicated long-term course of a VITT patient with extremely high titers of pathogenic anti-platelet factor 4 (PF4)-IgG antibodies. Methods: Clinical and laboratory findings are presented, including the course of platelet counts, D-Dimer levels, clinical presentation, imaging, SARS-CoV-2-serological and immunological, platelet activating anti-PF4-IgG, as well as autopsy findings. Results: The patient presented with extended superior sagittal sinus thrombosis with accompanying bifrontal intracerebral hemorrhage. Repeated treatment with intravenous immune globuline (IVIG) resolved recurrent episodes of thrombocytopenia. Moreover, the patient’s serum remained strongly positive for platelet-activating anti-PF4-IgG over three months. After a period of clinical stabilization, the patient suffered a recurrent and fatal intracranial hemorrhage. Conclusions: Complicated VITT with extremely high anti-PF4-IgG titers over three months can induce recurrent thrombocytopenia despite treatment with IVIG and anticoagulation. Plasma exchange, immunoadsorption, and /or immunosuppressive treatment may be considered in complicated VITT to reduce extraordinarily high levels of anti-PF4-IgG. Long-term therapy in such cases must take the individual bleeding risk and CSVT risk into account.

Superior sagittal sinus thrombosis induced by thyrotoxicosis

2001 ◽  
Vol 94 (1) ◽  
pp. 130-132 ◽  
Author(s):  
Cheng-Shyuan Rau ◽  
Chun-Chung Lui ◽  
Cheng-Loong Liang ◽  
Han-Jung Chen ◽  
Yeh-Lin Kuo ◽  
...  
Keyword(s):  
Intracranial Hemorrhage ◽  
Superior Sagittal Sinus ◽  
Sinus Thrombosis ◽  
Venous Blood ◽  
Fibrinogen Concentration ◽  
Venous Blood Flow ◽  
Content Type ◽  
Sagittal Sinus ◽  
Low Protein ◽  
Diffuse Goiter

✓ There is a wide variety of disorders associated with thrombosis of the superior sagittal sinus (SSS), including infectious disease, noninfectious conditions such as vasculitis and hypercoagulable states, and complications arising from pregnancy or use of oral contraceptive medications. Despite these well-defined associations, approximately 25% of the cases remain idiopathic. In this article the authors describe a patient who was found to have SSS thrombosis while experiencing a thyrotoxic phase of Graves disease. The patient presented with intracerebral hemorrhage, subarachnoid hemorrhage, seizure, coma, a raised fibrinogen concentration, low protein C activity, and atrial fibrillations. Thrombolysis was successfully performed despite the coexistence of thrombosis and intracranial hemorrhage. Patients with thyrotoxicosis and a diffuse goiter may be predisposed to the development of SSS thrombosis, as a result of hypercoagulation and stasis of local venous blood flow. In the present case, a patient in whom thrombosis coexisted with intracranial hemorrhage was successfully treated using thrombolytic therapy.

scholarly journals Hyperthyroidism as a Precipitant Factor for Cerebral Venous Thrombosis: A Case Report

2020 ◽  
Vol 8 ◽  
pp. 232470962094930
Author(s):  
Ahmed Elkhalifa Elawad Elhassan ◽  
Mohammed Omer Khalil Ali ◽  
Amina Bougaila ◽  
Mohammed Abdelhady ◽  
Hassan Abuzaid
Keyword(s):  
Case Report ◽  
Superior Sagittal Sinus ◽  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Laboratory Findings ◽  
Sagittal Sinus ◽  
History Of ◽  
Sagittal Sinus Thrombosis ◽  
Superior Sagittal Sinus Thrombosis

Cerebral venous sinus thrombosis (CVT) is an uncommon yet serious condition. While CVT has many known precipitants and etiologies, hyperthyroidism as a precipitant of CVT is not well understood. This study reported a case of a 41-year-old male with a 4-year history of hyperthyroidism presented with seizure. Consequently, a diagnosis of superior sagittal sinus thrombosis was confirmed by computed tomography and magnetic resonance (MR) venograms. Extensive investigations yielded no apparent underlying cause, but laboratory findings were consistent with uncontrolled hyperthyroidism. The patient improved rapidly following anticoagulation. Follow-up MR and MRV scans 2 months after treatment revealed full recanalization of the superior sagittal sinus. This case report highlighted hyperthyroidism, as a procoagulant condition, resulting specifically in superior sagittal sinus thrombosis.

scholarly journals The Inhibitory Effect of Protamine on Platelets is Attenuated by Heparin without Inducing Thrombocytopenia in Rodents

Marine Drugs ◽  
2019 ◽  
Vol 17 (9) ◽  
pp. 539
Author(s):  
Joanna Miklosz ◽  
Bartlomiej Kalaska ◽  
Kamil Kaminski ◽  
Malgorzata Rusak ◽  
Krzysztof Szczubialka ◽  
...  
Keyword(s):  
Factor Xa ◽  
Bleeding Risk ◽  
Inhibitory Effect ◽  
Antiplatelet Activity ◽  
Short Term ◽  
Platelet Factor ◽  
Antithrombotic Activity ◽  
Formation Number ◽  
Induced Aggregation

Protamine sulfate (PS) is a polycationic protein drug obtained from the sperm of fish, and is used to reverse the anticoagulant effect of unfractionated heparin (UFH). However, the interactions between PS, UFH, and platelets are still not clear. We measured the platelet numbers and collagen-induced aggregation, P-selectin, platelet factor 4, β-thromboglobulin, prostacyclin metabolite, D-dimers, activated partial thromboplastin time, prothrombin time, anti-factor Xa, fibrinogen, thrombus weight and megakaryocytopoiesis in blood collected from mice and rats in different time points.. All of the groups were treated intravenously with vehicle, UFH, PS, or UFH with PS. We found a short-term antiplatelet activity of PS in mice and rats, and long-term platelet-independent antithrombotic activity in rats with electrically-induced thrombosis. The antiplatelet and antithrombotic potential of PS may contribute to bleeding risk in PS-overdosed patients. The inhibitory effect of PS on the platelets was attenuated by UFH without inducing thrombocytopenia. Treatment with UFH and PS did not affect the formation, number, or activation of platelets, or the thrombosis development in rodents.

scholarly journals Long-term follow-up including extensive complement analysis of a pediatric C3 glomerulopathy cohort

2021 ◽  
Author(s):  
Marloes A. H. M. Michels ◽  
Kioa L. Wijnsma ◽  
Roel A. J. Kurvers ◽  
Dineke Westra ◽  
Michiel F. Schreuder ◽  
...  
Keyword(s):  
Mixed Model ◽  
Linear Mixed Model ◽  
Immunosuppressive Treatment ◽  
Complement C3 ◽  
C3 Glomerulopathy ◽  
Laboratory Findings ◽  
Mixed Model Analysis ◽  
Long Term Follow Up

Abstract Background C3 glomerulopathy (C3G) is a rare kidney disorder characterized by predominant glomerular depositions of complement C3. C3G can be subdivided into dense deposit disease (DDD) and C3 glomerulonephritis (C3GN). This study describes the long-term follow-up with extensive complement analysis of 29 Dutch children with C3G. Methods Twenty-nine C3G patients (19 DDD, 10 C3GN) diagnosed between 1992 and 2014 were included. Clinical and laboratory findings were collected at presentation and during follow-up. Specialized assays were used to detect rare variants in complement genes and measure complement-directed autoantibodies and biomarkers in blood. Results DDD patients presented with lower estimated glomerular filtration rate (eGFR). C3 nephritic factors (C3NeFs) were detected in 20 patients and remained detectable over time despite immunosuppressive treatment. At presentation, low serum C3 levels were detected in 84% of all patients. During follow-up, in about 50% of patients, all of them C3NeF-positive, C3 levels remained low. Linear mixed model analysis showed that C3GN patients had higher soluble C5b-9 (sC5b-9) and lower properdin levels compared to DDD patients. With a median follow-up of 52 months, an overall benign outcome was observed with only six patients with eGFR below 90 ml/min/1.73 m2 at last follow-up. Conclusions We extensively described clinical and laboratory findings including complement features of an exclusively pediatric C3G cohort. Outcome was relatively benign, persistent low C3 correlated with C3NeF presence, and C3GN was associated with higher sC5b-9 and lower properdin levels. Prospective studies are needed to further elucidate the pathogenic mechanisms underlying C3G and guide personalized medicine with complement therapeutics. Graphical abstract

scholarly journals P.056 Intracranial hemorrhage as initial presentation of sagittal sinus thrombosis: review of 3 cases

2017 ◽  
Vol 44 (S2) ◽  
pp. S27-S27
Author(s):  
JY Chu
Keyword(s):  
Intracranial Hemorrhage ◽  
Cerebral Hemorrhage ◽  
Motor Vehicle ◽  
Sinus Thrombosis ◽  
Anticoagulation Therapy ◽  
Transverse Sinus ◽  
Sagittal Sinus ◽  
Oral Warfarin ◽  
Sagittal Sinus Thrombosis ◽  
Ct And Mri

Background: Intracranial hemorrhage due to sagittal sinus thrombosis is an unusal inital clinical presentation and a series of 3 cases is presented. Methods: A retrospective study of stroke patients seen at the William Osler Health System between 2014 -2016. Results: 1: 43 y.o. female presented with headaches and right hemiparesis. CT and MRI/MRV showed L. parietal intra-cerebral hemorrhage and sagittal and transverse sinus thrombosis. She was treated with IV heparin and subsequent oral Warfarin but developed symptomatic left subdural hematoma which was successfully evacuated. Hypercoagulable workup was negative. Subsequent MRI/MRV showed resolution of her sinus thrombosis and received asparin only since. 2: 45 y.o. male presented with generalized seizure 10 days following a motor vehicle accident. Initial CT showed focal right frontal subarachnoid hemorrhage and subsequent MRI/MRV confirmed extensive sagittal sinus thrombosis. He was treated with IV heparin and subsequent Warfarin without any complications. 3: 32 y.o. male presented with generalized seizure. CT and MRI/MRV confirmed a large right temporal lobe intra-cerebral hemorrhage and extensive right transverse sinus and straight sinus thrombosis. He was successfully treated with IV heparin followed by oral Warfarin. Conclusions: Despite intracranial hemorrhage in patients with cerebral sinus venous thrombosis, they could be managed successfully with anticoagulation therapy and with careful clinical and neuro-imaging monitoring.

Laboratory Findings on a Patient with Strongyloies Stercoralis Pulmonary Infection after Long Term Steroid Hormone and Immunosuppressive Treatment

2020 ◽  
Author(s):  
Hongying Zhao ◽  
Shuang Deng ◽  
Yuanzi Liang ◽  
Zhiqiang Qin ◽  
Li Liang ◽  
...  
Keyword(s):  
Pulmonary Infection ◽  
Immunosuppressive Agents ◽  
Immunosuppressive Treatment ◽  
Community Acquired Pneumonia ◽  
Laboratory Findings ◽  
Infected Woman ◽  
Infected Female ◽  
Clinical Presentations ◽  
Imaging Results

Abstract Background: Strongyloies stercoralis infection is common in tropical and humid areas worldwide. However, strongyloidiasis caused by Strongyloies stercoralis infection is often neglected in clinic. We report a misdiagnosed case of Strongyloies stercoralis infected female patient who had been admitted to four different hospitals for treatment, she eventually died upon Strongyloies stercoralis hyperinfection with pulmonary infection involved.Case presentation: A Strongyloies stercoralis infected woman was misdiagnosed as community acquired pneumonia, connective tissue disease and Sjogren's syndrome, and treated by mistake.She eventually died upon Strongyloies stercoralis hyperinfection with pulmonary infection involved. The patient’s clinical presentations, imaging results of the lungs, numerous Strongyloies Stercoralis larvae and eggs found in the stool, increased eosenophil count in peripheral blood, and elevated serological IgE level were evidences of Strongyloies stercoralis hyperinfection.Conclusion: The patient was infected with Strongyloies Stercoralis and died from the hyperinfection after long term use of immunosuppressive agents.

scholarly journals Syndrome of cerebral venous sinus thrombosis and thrombocytopenia after vaccination for COVID-19

2021 ◽  
Author(s):  
Babak Soleimani ◽  
Sanchit Turaga ◽  
Dalia Khan ◽  
Claire Davies ◽  
Yaw Duodu ◽  
...  
Keyword(s):  
Sinus Thrombosis ◽  
Case Series ◽  
Multidisciplinary Care ◽  
Intravenous Immunoglobulins ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Laboratory Findings ◽  
Platelet Factor ◽  
Venous Sinus Thrombosis ◽  
Decompressive Hemicraniectomy

Abstract Experience in the management of COVID-19 vaccine induced thrombosis and thrombocytopenia is currently lacking. In this case series we report the presentation and our experience in the management of cerebral venous sinus thrombosis and thrombocytopenia post ChAdOx1 nCoV-19 vaccination. Two of the three cases had confirmed anti-platelet factor 4 antibodies and extracranial thrombosis. In all the cases, plasma exchange, intravenous immunoglobulins and steroids normalised the platelet count and intravenous argatroban was used for initial anticoagulation. Two cases received a platelet transfusion and required decompressive hemicraniectomy due to raised intracranial pressure, secondary to cerebral oedema and haemorrhage. Prompt assessment of a new persistent headache occurring between 5 and 28 days of receiving the ChAdOx1 nCoV-19 vaccine is warranted irrespective of age. In cases with venous thrombosis on imaging or abnormal laboratory findings (thrombocytopenia, abnormal clotting or elevated D-dimer), urgent transfer to a tertiary centre is recommended for multidisciplinary care and prevention of life-threatening complications from this rare syndrome.

scholarly journals Thrombosis and thrombocytopaenia after ChAdOx1 nCoV-19 vaccination: a single UK centre experience

2021 ◽  
Vol 14 (7) ◽  
pp. e243894
Author(s):  
Fehmida Bano ◽  
Buddikha Badugama ◽  
Deepak Chandra
Keyword(s):  
Sinus Thrombosis ◽  
Clinical Findings ◽  
High Titre ◽  
University Teaching ◽  
Reference Laboratory ◽  
Laboratory Findings ◽  
Platelet Factor ◽  
The Uk ◽  
Time Of Presentation ◽  
D Dimer

We report clinical findings of three patients presenting with thrombosis and thrombocytopaenia 10–16 days following the first dose of the ChAdOx1 nCoV-19 vaccine against SARS-CoV-2. All patients presented to a major university teaching hospital in the UK over a 5-day period and were found to have high-titre antibodies against platelet factor 4 (PF4) without previous exposure to heparin. All three patients presented with extensive venous thrombosis, significant thrombocytopaenia, elevated D-dimer and borderline low fibrinogen. Two had fatal intracerebral haemorrhage secondary to cavernous venous sinus thrombosis and one had PE. Reference laboratory testing of serum demonstrated anti-PF4 antibodies in all three patients. The clinical and laboratory findings confirmed vaccine-induced thrombotic thrombocytopaenia (VITT) which was poorly described at the time of presentation. We were able to manage successfully one patient with PE with intravenous immunoglobulin and corticosteroids.

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