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28 décembre 2023
- doi: 10.1182/blood.2023022136
- issn: 0006-4971
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info:eu-repo/semantics/altIdentifier/doi/10.1182/blood.2023022136
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info:eu-repo/semantics/altIdentifier/pmid/37883798
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info:eu-repo/semantics/altIdentifier/eissn/1528-0020
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info:eu-repo/semantics/altIdentifier/urn/urn:nbn:ch:serval-BIB_08EBA4C949765
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Immune globulins Antibodies Immune serum globulinCiter ce document
L. Schönborn et al., « Anti-PF4 immunothrombosis without proximate heparin or adenovirus vector vaccine exposure. », Serveur académique Lausannois, ID : 10.1182/blood.2023022136
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Platelet-activating anti-platelet factor 4 (PF4)/heparin antibodies and anti-PF4 antibodies cause heparin-induced thrombocytopenia (HIT) and vaccine-induced immune thrombocytopenia and thrombosis (VITT), respectively. Diagnostic and treatment considerations differ somewhat between HIT and VITT. We identified patients with thrombocytopenia and thrombosis without proximate heparin exposure or adenovirus-based vaccination who tested strongly positive by PF4/polyanion enzyme-immunoassays and negative/weakly positive by heparin-induced platelet activation (HIPA) test but strongly positive by PF4-induced platelet activation (PIPA) test (ie, VITT-like profile). We tested these patients by a standard chemiluminescence assay that detects anti-PF4/heparin antibodies found in HIT (HemosIL AcuStar HIT-IgG(PF4-H)) as well as a novel chemiluminescence assay for anti-PF4 antibodies found in VITT. Representative control sera included an exploratory anti-PF4 antibody-positive but HIPA-negative/weak cohort obtained before 2020 (n = 188). We identified 9 patients with a clinical-pathological profile of a VITT-like disorder in the absence of proximate heparin or vaccination, with a high frequency of stroke (arterial, n = 3; cerebral venous sinus thrombosis, n = 4), thrombocytopenia (median platelet count nadir, 49 × 109/L), and hypercoagulability (greatly elevated D-dimer levels). VITT-like serological features included strong reactivity by PIPA (aggregation