Aidan at 08:41, 29 April 2021

2021-04-29T08:41:10Z

← Older revision		Revision as of 08:41, 29 April 2021
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	== Background ==		==Background==

	* Very rare		*Very rare

	== Clinical Presentation ==		==Clinical Presentation==

	* Follows recent vaccination within 4 to 30 days		*Follows recent vaccination within 4 to 30 days
	* Can present with severe headache, visual changes, abdominal pain, nause and vomiting, back pain, dyspnea, leg pain or swelling, petechiae and easy bruising		*Can present with severe headache, visual changes, abdominal pain, nause and vomiting, back pain, dyspnea, leg pain or swelling, petechiae and easy bruising

	== Investigations ==		==Investigations==

	* CBC with platelet count and peripheral smear		*CBC with platelet count and peripheral smear
	* Imaging tor thrombosis based on the patient's signs and symptoms		*Imaging tor thrombosis based on the patient's signs and symptoms
	* PF4-ELISA [[Heparin-induced thrombocytopenia\|HIT]] assay, drawn before starting treatment		*PF4-ELISA [[Heparin-induced thrombocytopenia\|HIT]] assay, drawn before starting treatment, which is almost always positive with optical density greater than 2
	* Fibrinogen		*Fibrinogen, which is often low
			*D-dimer, which is usually markedly elevated

	== Diagnosis ==		==Diagnosis==

	* All four criteria must be met:		*All four criteria must be met:
	** Recent COVID vaccine within 4 to 30 days previously		**Recent COVID vaccine within 4 to 30 days previously
	*** So far only Johnson & Johnson and AstraZeneca		***So far only Johnson & Johnson and AstraZeneca
	** Thrombosis, often cerebral or abdominal		**Thrombosis, often cerebral or abdominal
	** Thrombocytopenia, though they may be normal early in the course of illness		**Thrombocytopenia, though they may be normal early in the course of illness
	** Positive PF4 HIT ELISA		**Positive PF4 HIT ELISA

	== Management ==		==Management==

	* Should be started if there are signs or symptoms of serious thrombosis and positive imaging or low platelets		*Should be started if there are signs or symptoms of serious thrombosis and positive imaging or low platelets
			*Treated similarly to [[heparin-induced thrombocytopenia]]
	* Should be treated with non-heparin anticoagulation
			**IVIg 1 g/kg daily for 2 days
			**Non-heparin anticoagulation, such as [[argatroban]], [[bivalrudin]], DOACs, [[fondaparinux]], or [[danaparoid]]
			**Thrombocytopenia or low fibrinogen are not absolute contraindications to anticoagulation, especially if platelets are >20 or rising
			**Avoid platelet transfusions, unless serious or life-threatening bleeding

	[[Category:Infectious diseases]]		[[Category:Infectious diseases]]

Aidan: Created page with "== Background == * Very rare == Clinical Presentation == * Follows recent vaccination within 4 to 30 days * Can present with severe headache, visual changes, abdominal pain..."

2021-04-25T00:52:45Z

Created page with "== Background == * Very rare == Clinical Presentation == * Follows recent vaccination within 4 to 30 days * Can present with severe headache, visual changes, abdominal pain..."

New page

== Background ==

* Very rare

== Clinical Presentation ==

* Follows recent vaccination within 4 to 30 days
* Can present with severe headache, visual changes, abdominal pain, nause and vomiting, back pain, dyspnea, leg pain or swelling, petechiae and easy bruising

== Investigations ==

* CBC with platelet count and peripheral smear
* Imaging tor thrombosis based on the patient's signs and symptoms
* PF4-ELISA [[Heparin-induced thrombocytopenia|HIT]] assay, drawn before starting treatment
* Fibrinogen

== Diagnosis ==

* All four criteria must be met:
** Recent COVID vaccine within 4 to 30 days previously
*** So far only Johnson & Johnson and AstraZeneca
** Thrombosis, often cerebral or abdominal
** Thrombocytopenia, though they may be normal early in the course of illness
** Positive PF4 HIT ELISA

== Management ==

* Should be started if there are signs or symptoms of serious thrombosis and positive imaging or low platelets
* Should be treated with non-heparin anticoagulation

[[Category:Infectious diseases]]
[[Category:Hematology]]

Vaccine-induced immune thrombotic thrombocytopenia - Revision history

Aidan at 08:41, 29 April 2021

Aidan: Created page with "== Background == * Very rare == Clinical Presentation == * Follows recent vaccination within 4 to 30 days * Can present with severe headache, visual changes, abdominal pain..."