Vaccine‐induced immune thrombotic thrombocytopenia: Consider IVIG batch in the treatment

Karnam, Anupama; Lacroix‐Desmazes, Sébastien; Kaveri, Srini V.; Bayry, Jagadeesh

Various vaccines have been developed recently to protect the population from corona virus disease-19 (COVID-19). Although the beneficial effects of vaccines outweigh the risks associated with vaccination, an unusual but life threatening thrombosis and thrombocytopenia has been observed in certain individuals who received recombinant adenoviral vector encoding spike protein of SARS-CoV-2 ChAdOx1 nCov-19 (AstraZeneca)1-4 . Exploration of underlying mechanisms have identified that ChAdOx1 nCov-19 vaccine-induced platelet-activating antibodies against platelet factor 4 (PF4) are responsible for these adverse events1-3 . Based on the in vitro experimental evidence that showed therapeutic potential of intravenous immunoglobulin (IVIG), a pooled normal IgG, in preventing the platelet activation by anti-PF4 antibodies, and also founded on the initial experience with IVIG-treatment in these patients1,2 , a recent report by Thaler et al. demonstrated a successful treatment of a vaccine-induced prothrombotic immune thrombocytopenic patient with high dose IVIG therapy5 .