COVID-19疫苗引發血栓併血小板低下症－病例報告

Thrombosis with Thrombocytopenia Syndrome after Vaccination with the COVID-19 AstraZeneca Vaccine: A Case Report

周奎伯(Kuei-Po Chou) ； 鍾慧(Huei Chung) ； 官玫秀(Mei-Hsiouh Guan)

《北市醫學雜誌》 預刊文章 Pp. 1-10

https://doi.org/10.6200/TCMJ.202201/PP.0052

摘要

新型冠狀病毒疾病（Coronavirus disease 2019, COVID-19）的疫情影響全球甚鉅，然而隨著COVID-19疫苗大規模施打，腺病毒載體疫苗也在多國被發現可能會導致罕見的血栓併血小板低下症候群（Thrombosis with Thrombocytopenia Syndrome, TTS）。有關施打COVID-19疫苗引起的TTS，大部分案例在施打14天內出現症狀，血栓位置以顱內靜脈、腹腔靜脈及肺臟為主，致死率大於60%。臨床診斷TTS的重點在於是否出現血小板低下及血栓，而根據目前國內外相關的指引，當臨床檢驗及症狀符合時，即可考慮開始治療並進行anti-PF4檢驗。本文報告一名87歲女性，疑似因施打AstraZeneca（AZ）COVID-19疫苗引發TTS，並討論TTS診斷、藥物治療及疫苗不良事件通報與評估。

關鍵字

嚴重特殊傳染性肺炎疫苗 ； 疫苗不良事件 ； 血栓併血小板低下症候群

並列摘要

The COVID-19 pandemic has a substantial global impact. However, with the implementation of a large-scale COVID-19 vaccination program, the adenoviral-vector vaccines, such as the COVID-19 AstraZeneca (AZ) vaccine, were found related to rare adverse reactions, namely thrombosis and thrombocytopenia syndrome (TTS). Most COVID-19 vaccine-induced TTS cases develop severe intracranial venous thrombosis, celiac venous thrombosis, or pulmonary thrombosis primarily within 14 days after vaccination. The mortality rate associated with TTS is greater than 60%. The diagnosis focuses on the emergence of thrombosis and thrombocytopenia. The current national and international guidelines recommend considering treatment initiation and anti-PF4 tests when the clinical tests and symptoms are consistent with TTS. This article reported an 87-year-old woman suspected of developing TTS after vaccination with the COVID-19 AZ vaccine. TTS diagnosis, drug treatment, vaccine adverse event reporting, and assessments were discussed.

並列關鍵字

COVID-19 vaccines ； vaccine adverse event (VAE) ； thrombosis with thrombocytopenia syndrome (TTS)