FEATURE
Immune Thrombocytopenic Purpura vs. Vaccine Induced Thrombotic Thrombocytopenia: Rare but Distinct Conditions Associated with the COVID-19 Vaccines By Glenn Goodwin, DO, PGY-2 Aventura Hospital & Medical Center
While the COVID-19 vaccine has surely saved thousands, if not millions of lives, there appears to be rare sequela of vaccinations that are as unique as the Sars-CoV-2 viral infection itself. One of the more worrisome adverse effects is the emergence of COVID vaccineinduced thrombotic thrombocytopenia (VITT). While superficially appearing to be closely related to COVID vaccineinduced immune thrombocytopenic purpura (ITP), the distinction is critical when determining a treatment strategy.
By Charles Latimore, MD, PGY-2 Aventura Hospital & Medical Center
infection, there has been conflicting and concerning data regarding the dangers of the spike protein itself. Emerging evidence suggests that the spike protein generated by our intramuscular and endothelial cells following administration of the COVID-19 vaccines may up-regulate a pro-thrombotic pathway via platelet factor 4 (PF4); the same molecule known to cause Heparin Induced Thrombocytopenia (HIT). Additionally,
By Annalee Baker, MD, FACEP
Residency Program Director & Associate Professor of EM, NYU Grossman School of Medicine
it is theorized that the lab-engineered lipid nanoparticle covering of the mRNA may lead to unpredictable absorption rates in the central nervous system, resulting in various neurological side effects. Since initiating COVID-19 vaccination of healthcare workers and the general population, rare occurrences of anaphylaxis have occurred. As of January 2021, only 21 cases of
Figure 1. Diagnosis of Vaccine Induced Thrombotic Thrombocytopenia
Currently, there are three COVID-19 vaccinations approved by the Food and Drug Administration (FDA) for use in the United States: PfizerBioNtech, Moderna and Johnson & Johnson (J&J), with J&J being the only single-dose formulation. While the J&J vaccine uses a traditional adenovirus vector, the other two vaccines are the first vaccines to use long-studied messenger RNA (mRNA) technology to deliver the immunogenic material to the host. The mRNA is translated to an endogenous version to the coronavirus spike protein, which engenders an immune response and is then quickly degraded, prior to being incorporated into the nucleus. This mRNA technology has actually been in existence for many years, employed in the treatment of certain cancers and genetic diseases. Although production of endogenous spike protein cannot cause an active 34
Image obtained from the Expert Hematology Panel on COVID-19 VITT with express written consent from the authors, Parvord et al. EMpulse Fall 2021
