呼吸道感染后血栓形成和血小板减少的小儿疫苗诱发免疫性血栓性血小板减少症样病例群--病例系列

IF 3.4 3区医学 Q2 HEMATOLOGY

Research and Practice in Thrombosis and Haemostasis Pub Date : 2024-10-01 DOI:10.1016/j.rpth.2024.102589

Dimitra Dimopoulou , Lida Mentesidou , Athina Dettoraki , Christina Karastathi , Maria Berikopoulou , Panagiota Katsouli , Ioanna Anastasopoulou , Iason G. Stamatakis , Theodora Bachou , Flora Tzifi , Aikaterini Michalopoulou , Anna Messaritaki , Vana Spoulou , Helen Pergantou

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引用次数: 0

摘要

背景腺病毒载体COVID-19疫苗诱导的免疫性血栓性血小板减少症（VITT）是一种肝素依赖性血小板激活障碍。关键临床问题探讨小儿感染后血栓和血小板减少症与 VITT 类疾病的关联。临床方法报告了三名患有严重血小板减少症、凝血功能障碍、D-二聚体升高和血栓事件（脑静脉窦血栓）的儿童。其中两名患儿的鼻咽样本腺病毒检测呈阳性，一名患儿感染了 A 组链球菌。他们都有 COVID-19 病史和低风险抗磷脂综合征。在两名儿童中发现了因子 V Leiden 的杂合子。2名患者进行了抗血小板因子4（PF4）血清学检测，PF4/多聚酶侧流免疫测定结果为阳性，但PF4/多聚酶化学发光免疫测定结果为阴性。所有患者都接受了依诺肝素或磺达肝癸和静脉注射免疫球蛋白的治疗，3 名患者接受了血小板输注和类固醇治疗。

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A cluster of pediatric vaccine-induced immune thrombotic thrombocytopenia–like cases with thrombosis and thrombocytopenia following respiratory infections—case series

Background

Adenoviral vector COVID-19 vaccine-induced immune thrombotic thrombocytopenia (VITT) is a heparin-independent platelet-activating disorder. An increasing number of VITT-like disorders without previous vaccination are being identified.

Key Clinical Question

To explore the association of the pediatric cluster of postinfectious thrombosis and thrombocytopenia with VITT-like disorders.

Clinical Approach

Three children with severe thrombocytopenia, coagulopathy, elevated D-dimer, and thrombotic events (cerebral venous sinus thrombosis) were reported. Two had positive nasopharyngeal samples for adenovirus, and 1 had group A streptococcus infection. They all had a COVID-19 history and low-risk antiphospholipid syndrome. Heterozygosity for factor V Leiden was found in 2 children. In 2 patients for whom anti–platelet factor 4 (PF4) serology was performed, positive results were found by PF4/polyanion lateral-flow immunoassay but negative results by PF4/polyanion chemiluminescence immunoassay. All patients were treated with enoxaparin or fondaparinux and intravenous immunoglobulin, while 3 received platelets transfusion and steroids.