Therapeutic plasma exchange (TPE) as a plausible rescue therapy in severe vaccine-induced immune thrombotic thrombocytopenia

Gail Rock; Viktoria Weber; Bernd Stegmayr

doi:10.1016/j.transci.2021.103174

Therapeutic plasma exchange (TPE) as a plausible rescue therapy in severe vaccine-induced immune thrombotic thrombocytopenia

Transfus Apher Sci. 2021 Aug;60(4):103174. doi: 10.1016/j.transci.2021.103174. Epub 2021 May 28.

Authors

Gail Rock¹, Viktoria Weber², Bernd Stegmayr³

Affiliations

¹ Canadian Apheresis Group, Ottawa, Canada. Electronic address: cag@cagcanada.ca.
² Department for Biomedical Research, Center for Biomedical Technology, Danube University, Krems, Austria. Electronic address: Viktoria.Weber@donau-uni.ac.at.
³ Department of Public Health and Clinical Medicine, Faculty of Medicine, Umea University, Umea, Sweden. Electronic address: bernd.stegmayr@medicin.umu.se.

PMID: 34088601
DOI: 10.1016/j.transci.2021.103174

Abstract

Vaccine-induced immune thrombotic thrombocytopenia (VITT) is associated with high titers of immunoglobulin G class antibodies directed against the cationic platelet chemokine platelet factor 4 (PF4). These antibodies activate platelets via FcγIIa receptors. VITT closely resembles heparin-induced thrombocytopenia. Inflammation and tissue trauma substantially increase the risk for forming pathogenic PF4 antibodies. We therefore propose the use of therapeutic plasma exchange as rescue therapy in VITT to deplete antibodies plus factors promoting inflammation such as excess cytokines in the circulation as well as extracellular vesicles derived from activated platelets.

Keywords: Antibodies; Apheresis; Covid-19; Platelets; Therapeutic plasma exchange; Therapy; Thrombocytopenia; VITT; Vaccine-induced immune thrombotic thrombocytopenia.

Publication types

Review

MeSH terms

Albumins
Antibody Specificity
Anticoagulants
Autoantibodies / immunology
COVID-19 Vaccines / adverse effects*
COVID-19 Vaccines / pharmacology
ChAdOx1 nCoV-19
Citrates
Contraindications, Procedure
Cytokines / blood
Extracellular Vesicles
Humans
Immunoglobulin G / immunology
Immunosuppression Therapy
Inflammation
Plasma Exchange* / adverse effects
Plasma Exchange* / methods
Platelet Activation
Platelet Factor 4 / immunology*
Platelet Transfusion / adverse effects
Purpura, Thrombotic Thrombocytopenic / etiology
Purpura, Thrombotic Thrombocytopenic / immunology
Purpura, Thrombotic Thrombocytopenic / therapy*
Registries
Salvage Therapy*
Thrombocytopenia / etiology
Thrombosis / etiology

Substances

Albumins
Anticoagulants
Autoantibodies
COVID-19 Vaccines
Citrates
Cytokines
Immunoglobulin G
PF4 protein, human
Platelet Factor 4
ChAdOx1 nCoV-19

Supplementary concepts

Thrombotic thrombocytopenic purpura, acquired