Acquired immune thrombotic thrombocytopenic purpura (TTP) associated with inactivated COVID-19 vaccine CoronaVac

Abstract

Corona virus disease 2019 (COVID-19) due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has affected the whole world. Acquired thrombotic thrombocytopenic purpura (TTP) has been reported after administration of mRNA- or adenoviral vector-based COVID-19 vaccines, including Ad26.COV2-S, BNT162b2, mRNA-1273, and ChAdOx1 nCov-19. However, whether inactivated vaccines, such as CoronaVac, could cause TTP and whether the symptoms in TTPs caused by inactivated vaccines are different from previously reported cases are unknown. In this study, two cases were reported. Both cases developed TTP after the second CoronaVac vaccination shot, but not the first. They demonstrated symptoms of fever, neurological abnormalities, renal dysfunction, thrombocytopenia, and hemolysis. Both patients achieved complete remission through several sessions of plasma exchanges and immune suppression. The incidence of TTP in Nanjing area was analyzed. The number of patients with TTP was 12 in 2019, 6 in 2020, 16 in 2021, and 19 in 2022. To the authors’ knowledge, this report is the first report of TTP associated with inactivated COVID-19 vaccine (CoronaVac). The rarity and delayed onset may be due to the relatively milder immune response caused by the inactivated vaccines than mRNA-based ones. Timely plasma exchange is a vital treatment for CoronaVac-related TTP, similar to activated vaccine-related TTP.

Keywords

thrombotic thrombocytopenia purpura (TTP) / corona virus disease 2019 (COVID-19) / CoronaVac / acute respiratory syndrome coronavirus 2 (SARS-CoV-2) / vaccine

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Acknowledgements

This study was supported by the National Natural Science Foundation of China (Nos. 81700130, 82370134, 92169114, and 81802932); the Natural Science Fund for Distinguished Young Scholars of Hubei Province (No. 2022CFA054), and the National Key Research and Development Program of China (No. 2018YFE0113600). The authors wish to thank Dr. Jiahua Ding, Qiqiang Long, Jie Su, Huixia Xiong, Hucheng Tang, and Qi Zhang for providing patient data.

Compliance with ethics guidelines

Conflicts of interest Zhangbiao Long, Suyu Jiang, Honglei Xin, Lu Zhang, Ruinan Lu, Fengqi Liu, Yong Xu, Linv Wang, Jun Wang, Xuezhong Zhang, Hui Liao, Jinning Shi, Xue Yan, Xiang Zhu, Ruonan Shao, Zijian Li, Yilin Zhu, Han Yan, Jiao Wu, Chao Fang, and Xiaofeng Shi declare no competing interests. Xiaodong Xi is an Editor of Frontiers of Medicine, and he was excluded from the peer-review process and all editorial decisions related to the acceptance and publication of this article. Peer review was handled independently by the other editors to minimize bias.

Informed consent was obtained from patients. The exemption for ethical approval was received because this study was retrospective.

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