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Vaccine-induced thrombosis and thrombocytopaenia with widespread abdominal venous thrombosis, venous ischaemia and bowel oedema
  1. Fabiha Parveen1,
  2. Khalid Mujahid1 and
  3. Shafiq Yusuff2
  1. 1Emergency Medicine, Princess Alexandra Hospital NHS Trust, Harlow, UK
  2. 2Medicine, Lister Hospital, Stevenage, UK
  1. Correspondence to Dr Fabiha Parveen; fabiha.parveen{at}nhs.net

Abstract

A 49-year-old woman presented with severe abdominal pain and per rectal bleed, 13 days after receiving the first dose of the AstraZeneca vaccine. Blood tests showed remarkably low platelet count, unmeasurable D-dimer levels and low fibrinogen levels, consistent with a diagnosis of vaccine-induced thrombotic thrombocytopaenia and disseminated intravascular coagulation. CT mesenteric angiogram revealed massive portosplenic mesenteric vein thrombosis. CT head also noted non-occlusive thrombosis at several sites. She was treated with intravenous immunoglobulins, plasma exchange, anticoagulants and transjugular intrahepatic portosystemic shunt procedure. Following a prolonged inpatient stay, she was discharged with subsequent short bowel syndrome and long-term parenteral nutrition. This particular clinical scenario aims to highlight the importance for clinicians to remain vigilant for rare complications associated with the AstraZeneca vaccine and the subsequent management involved, at a time where it is vital to vaccinate globally in order to control the spread of the COVID-19 pandemic.

  • COVID-19
  • Immunological products and vaccines
  • Haematology (drugs and medicines)
  • Emergency medicine
  • Haematology (incl blood transfusion)

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Footnotes

  • Contributors We would like to thank Addenbrookes hospital for all their care towards the patient. FP is the first author of this case. Supervised by both KM and SY.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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