新冠肺炎疫苗引起免疫血栓性血小板低下症－診斷與治療

COVID-19 Vaccine Induced Immune Thrombotic Thrombocytopenia-Diagnosis and Treatment

周盈甄(Ying-Chen Chou)

《北市醫學雜誌》 預刊文章 Pp. 1-6

https://doi.org/10.6200/TCMJ.202201/PP.0018

摘要

台灣自5月新冠疫情爆發以來，民眾陸續接種疫苗；但隨之而來的疫苗副作用患者湧現全台急診室，血管栓塞為少數但嚴重的副作用之一。這篇研究主要參考國外文獻，如何診斷及治療血管栓塞，建立簡潔明瞭流程圖。如果病人打完疫苗一個月內，出現血管栓塞症狀，且血小板下降、D-dimer上升、Anti-Platelet Factor 4 （Anti-PF4）antibody檢驗，可透過影像學檢查進行診斷；診斷後可給予類固醇、新型口服抗凝血劑（new oral anticoagulants, NOACs）、免疫球蛋白（intravenous immune globulin, IVIG）治療，治療後恢復率依序為44.4%、59.1%、56.6%。急診病人出現施打新冠疫苗後血管栓塞症狀，依據流程圖，可以有效率的給予檢查、診斷和即時的治療。

關鍵字

疫苗引起免疫血栓性血小板低下症 ； 類固醇 ； 新型口服抗凝血劑 ； 免疫球蛋白

並列摘要

People have been receiving vaccination since the COVID-19 pandemic swept over Taiwan in May 2021, along with patients suffering from vaccine side effects in the emergent departments all around Taiwan. Although it rarely occurs, Vaccine-Induced Immune Thrombotic Thrombocytopenia (VITT) is one of the severe adverse effects. This article summarizes findings from foreign literature on the diagnosis and treatment of VITT and yields a simple and explicit protocol. An imaging examination can be used to investigate the patients who develop thrombotic symptoms within one month after vaccination. Other valuable indicators include a decrement of platelet count and an increment of D-dimer, and the specific binding features of the anti-platelet factor 4 antibody. Steroid, new oral anticoagulants (NOACs), or intravenous immune globulin (IVIG) can be prescribed upon confirming the diagnosis, and the recovery rate after treatment are 44.4%, 59.1%, and 56.6%, respectively. By following the protocol, patients presenting the thrombotic symptoms after the COVID-19 vaccination can be effectively examined, diagnosed, and treated immediately.

並列關鍵字

vaccine-induced immune thrombotic thrombocytopenia (VITT) ； steroids ； new oral anticoagulants (NOACs) ； intravenous immune globulin (IVIG)