{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T01:38:13Z","timestamp":1789609093988,"version":"build-2803163510"},"reference-count":18,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2021,10,21]],"date-time":"2021-10-21T00:00:00Z","timestamp":1634774400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Clinical Apheresis"],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Vaccine\u2010induced immune thrombotic thrombocytopenia (VITT) is a newly described hematologic disorder, which presents as acute thrombocytopenia and thrombosis after administration of the ChAdOx1 nCov\u201019 (AstraZeneca) and Ad26.COV2.S (Johnson &amp; Johnson) adenovirus\u2010based vaccines against COVID\u201019. Due to positive assays for antibodies against platelet factor 4 (PF4), VITT is managed similarly to autoimmune heparin\u2010induced thrombocytopenia (HIT) with intravenous immunoglobulin (IVIG) and non\u2010heparin anticoagulation. We describe a case of VITT in a 50\u2010year\u2010old man with antecedent alcoholic cirrhosis who presented with platelets of 7\u2009\u00d7\u200910<jats:sup>3<\/jats:sup>\/\u03bcL and portal vein thrombosis 21\u2009days following administration of the Ad26.COV2.S COVID\u201019 vaccine. The patient developed progressive thrombosis and persistent severe thrombocytopenia despite IVIG, rituximab and high\u2010dose steroids and had persistent anti\u2010PF4 antibodies over 30\u2009days after his initial presentation. As such, delayed therapeutic plasma exchange (TPE) was pursued on day 32 of admission as salvage therapy, with a sustained improvement in his platelet count. Our case serves as proof\u2010of\u2010concept of the efficacy of TPE in VITT.<\/jats:p>","DOI":"10.1002\/jca.21945","type":"journal-article","created":{"date-parts":[[2021,10,21]],"date-time":"2021-10-21T12:09:28Z","timestamp":1634818168000},"page":"117-121","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Refractory vaccine\u2010induced immune thrombotic thrombocytopenia (<scp>VITT<\/scp>) managed with delayed therapeutic plasma exchange (<scp>TPE<\/scp>)"],"prefix":"10.1002","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7261-1335","authenticated-orcid":false,"given":"Ajay","family":"Major","sequence":"first","affiliation":[{"name":"Department of Medicine, Section of Hematology\/Oncology The University of Chicago  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Carll","sequence":"additional","affiliation":[{"name":"Department of Pathology The University of Chicago  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clarence W.","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Pathology The University of Chicago  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chancey","family":"Christenson","sequence":"additional","affiliation":[{"name":"Department of Pathology The University of Chicago  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatima","family":"Aldarweesh","sequence":"additional","affiliation":[{"name":"Department of Pathology The University of Chicago  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3335-2905","authenticated-orcid":false,"given":"Geoffrey D.","family":"Wool","sequence":"additional","affiliation":[{"name":"Department of Pathology The University of Chicago  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth S.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of Medicine, Section of Hematology\/Oncology The University of Chicago  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,10,21]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2105385"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2104840"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2104882"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc2105869"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.7517"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.7326\/L21-0244"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2109908"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/jth.15341"},{"key":"e_1_2_9_10_1","unstructured":"International Society on Thrombosis and Haemostasis (ISTH). The ISTH Releases Interim Guidance on Vaccine\u2010Induced Immune Thrombotic Thrombocytopenia (VITT). International Society on Thrombosis and Haemostasis. 2021 [cited 2021Jul1]. Available from:https:\/\/www.isth.org\/news\/561406\/The\u2010ISTH\u2010Releases\u2010Interim\u2010Guidance\u2010on\u2010Vaccine\u2010Induced\u2010Immune\u2010Thrombotic\u2010Thrombocytopenia\u2010VITT\u2010.htm."},{"key":"e_1_2_9_11_1","unstructured":"British Society for Haematology. Guidance produced by the Expert Haematology Panel (EHP) focused on Vaccine Induced Thrombosis and Thrombocytopenia (VITT). British Society for Haematology. 2021 [cited 2021Jul1]. Available from:https:\/\/b\u2010s\u2010h.org.uk\/about\u2010us\/news\/guidance\u2010produced\u2010by\u2010the\u2010expert\u2010haematology\u2010panel\u2010ehp\u2010focussed\u2010on\u2010vaccine\u2010induced\u2010thrombosis\u2010and\u2010thrombocytopenia\u2010vitt\/."},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/trf.15105"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2107051"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/trf.16018"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1055\/a-1469-7481"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/ijlh.13629"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc2109465"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.transci.2021.103174"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2021-326984"}],"container-title":["Journal of Clinical Apheresis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jca.21945","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jca.21945","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jca.21945","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,25]],"date-time":"2023-08-25T22:36:52Z","timestamp":1693003012000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jca.21945"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,21]]},"references-count":18,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,2]]}},"alternative-id":["10.1002\/jca.21945"],"URL":"https:\/\/doi.org\/10.1002\/jca.21945","archive":["Portico"],"relation":{},"ISSN":["0733-2459","1098-1101"],"issn-type":[{"value":"0733-2459","type":"print"},{"value":"1098-1101","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,21]]},"assertion":[{"value":"2021-07-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-10-09","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-10-21","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}