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Rare But Emerging Conditions Associated with COVID-19 Vaccines

By Glenn Goodwin, DO; Charles Latimore, MD; and Annalee Baker, MD, FACEP | on November 23, 2021 | 0 Comment
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Figure 1: Clinical findings included hemorrhagic bullae in the buccal region of the patient’s mouth (left) and scattered petechiae on his lower extremities (right)

Key Points

  • There are extremely rare side effects associated with the three FDA-approved COVID-19 vaccines.
  • Utilize D-dimer to differentiate between vaccine-induced ITP and VITT in the emergency department.
  • Differentiating between vaccine-induced ITP and VITT is important because these entities require different interventions and management.

References

  1. Silverman MA. Immune thrombocytopenia (ITP) in emergency medicine. Medscape website. Accessed Sept. 10, 2021.
  2. Sangli S, Virani A, Cheronis N, et al. Thrombosis with thrombocytopenia after the messenger RNA-1273 vaccine [published online ahead of print June 29, 2021]. Ann Intern Med. 2021;174(10):1480-1482.
  3. Cines DB, Bussel JB. SARS-CoV-2 vaccine-induced immune thrombotic thrombocytopenia. N Engl J Med. 2021;384(23):2254-2256.
  4. Johnson & Johnson’s Janssen. Centers for Disease Control and Prevention website. Accessed Sept. 10, 2021.
  5. Pfizer-BioNTech. Centers for Disease Control and Prevention website. Accessed Sept. 10, 2021.
  6. Moderna. Centers for Disease Control and Prevention website. Sept. 10, 2021.
  7. Schoenmaker L, Witzigmann D, Kulkarni JA, et al. mRNA-lipid nanoparticle COVID-19 vaccines: structure and stability. Int J Pharm. 2021;601:120586.
  8. Heublein M, Gandhi M, Chiu C, et al.  COVID-19 Vaccines with Dr. Monica Gandhi. The Curbsiders website. Accessed Sept. 10, 2021.
  9. Pavord S, Lester W, Makris M, et al. Guidance from the expert haematology panel (EHP) on Covid-19 vaccine-induced immune thrombocytopenia and thrombosis (VITT). British Society for Haematology website. Accessed Sept. 10, 2021.
  10. Kowarz E, Krutzke L, Reis J, et al. “Vaccine-induced Covid-19 mimicry” syndrome: splice reactions within the SARS-CoV-2 spike open reading frame result in spike protein variants that may cause thromboembolic events in patients immunized with vector-based vaccines. Research Square website. Accessed Sept. 10, 2021.
  11. Lu L, Xiong W, Mu J, et al. The potential neurological effect of the COVID-19 vaccines: a review. Acta Neurol Scand. 2021;144(1):3-12.
  12. Greinacher A, Thiele T, Warkentin TE, et al. A prothrombotic thrombocytopenic disorder resembling heparin-induced thrombocytopenia following coronavirus-19 vaccination. Research Square website. Accessed Sept. 10, 2021.
  13. Greinacher A, Selleng K, Mayerle J, et al. Anti-SARS-CoV-2 spike protein and anti-platelet factor 4 antibody responses induced by COVID-19 disease and ChAdOx1 nCov-19 vaccination. Research Square website. Accessed Sept. 10, 2021.
  14. Arepally GM, Padmanabhan A. Heparin-induced thrombocytopenia: a focus on thrombosis. Arterioscler Thromb Vasc Biol. 2021;41(1):141-152. doi:10.1161/ATVBAHA.120.315445.
  15. Immune thrombocytopenia. National Organization for Rare Disorders website. Accessed Sept. 10, 2021.
  16. Zeller B, Helgestad J, Hellebostad M, et al. Immune thrombocytopenic purpura in childhood in Norway: a prospective, population-based registration. Pediatr Hematol Oncol. 2000;17(7):551-558.
  17. Dominguez M. Immune thrombocytopenia (ITP). Medbullets website. Accessed Sept. 10, 2021.
  18. Patriarcheas V, Pikoulas A, Kostis M, et al. Heparin-induced thrombocytopenia: pathophysiology, diagnosis and management. Cureus. 2020;12(3):e7385.
  19. Linkins LA. Heparin induced thrombocytopenia. BMJ. 2015;350:g7566.
  20. Warkentin TE, Pai M, Linkins LA. Direct oral anticoagulants for treatment of HIT: update of Hamilton experience and literature review. Blood. 2017;130(9):1104-1113.
  21. Padmanabhan A, Jones CG, Pechauer SM, et al. IVIg for treatment of severe refractory heparin-induced thrombocytopenia. Chest. 2017;152(3):478-485.

 

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Explore This Issue
ACEP Now: Vol 40 – No 11 – November 2021

Pages: 1 2 3 4 5 | Single Page

Topics: Case ReportsCOVID-19immune thrombocytopenic purpura (ITP)PurpuraVaccinevaccine-induced thrombotic thrombocytopenia (VITT)

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