Laboratory results of a patient presenting with thrombocytopenia and multiple thromboses after vaccination with ChAdOx1 nCoV-19
| . | 11 . | 14 . | 15 . | 16 . | 17 . | 18 . | 19 . |
|---|---|---|---|---|---|---|---|
| Hematology | |||||||
| Hemoglobin, g/dL (ref., 11.8-15.3) | 13.4 | 13.9 | 13.7 | 12.3 | 11.6 | 11.5 | 10.8 |
| Platelets, ×109/L (ref., 145-390) | 57 | 56 | 70 | 88 | 119 | 159 | 187 |
| Platelets, citrate, ×109/L (ref., 145-390) | 39 | 46 | |||||
| Leukocytes, ×109/L (ref., 3.-8.8) | 11.0 | 11.0 | 11.0 | 10.3 | 12.1 | 10.1 | 9.1 |
| Basophils, ×109/L (ref., 0.01-0.10) | 0.05 | 0.07 | 0.07 | 0.11 | 0.06 | — | — |
| Eosinophils, ×109/L (ref., 0.01-0.5) | 0.27 | 0.20 | 0.36 | 0.51 | 0.71 | — | — |
| Monocytes, ×109/L (ref., 0.2-0,80) | 0.98 | 0.71 | 1.13 | 1.10 | 0.88 | — | — |
| Neutrophils, ×109/L (ref., 1.6-5.9) | 6.25 | 4.51 | 4.45 | 6.10 | 4.02 | — | — |
| Lymphocytes, ×109/L (ref., 1.0-3.5) | 3.42 | 5.61 | 4.99 | 4.93 | 5.26 | — | — |
| D-dimer, mg/L FEU (ref., <0.5) | — | >20 | 12 | 5.9 | 4.1 | 1.6 | 1.2 |
| CRP, mg/L (ref., <10) | 36 | 19 | 14 | 18 | 21 | 26 | 22 |
| Hemostasis | |||||||
| INR | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | 1.1 | 1.0 |
| Clotting factors II, VII, X (ref., >0.60) | 0.91 | 1.01 | 1.11 | 1.05 | 0.99 | 0.90 | 0.97 |
| aPTT, s (ref., 25-37) | — | 38 | 39 | 36 | 38 | 40 | 43 |
| Plasma fibrinogen, mg/dL (ref., 180-350) | — | 78 | 85 | 139 | 176 | 244 | 244 |
| ADAMTS13 protein, kIU/L (ref., 0.61-1.31) | — | — | — | 1.07 | — | — | — |
| Thrombophilia | |||||||
| Homocysteine, μmol/L (ref., <15.0) | — | — | — | 6.2 | — | — | — |
| Antithrombin, ×103IU/L (ref., 0.83-1.15) | — | 0.99 | 1.03 | 0.95 | 1.04 | 1.13 | 1.12 |
| Protein C, ×103 IU/L (ref., 0.70-1.30) | — | — | — | 1.20 | — | — | — |
| Protein S, ×103 IU/L (ref., 0.57-1.30) | — | — | — | 0.85 | — | — | — |
| Factor V Leiden R506Q mutation | — | — | — | Not detected | — | — | — |
| Prothrombin gene mutation (G20210A) | — | — | — | Heterozygous | — | — | — |
| Lupus anticoagulant | — | — | — | NA* | — | — | — |
| Cardiolipin IgG/IgM, ×103 IU/L (ref., <10.0) | — | — | — | 2.2/2.5 | — | — | — |
| β-2-GP1 IgG/IgM, kU/L (ref., 0-10) | — | — | — | <0.6 /<0.9 | — | — | — |
| Organ marker | |||||||
| ALT, U/L (ref., 10-45) | 29 | 61 | — | 134 | 123 | 115 | 95 |
| Serology | |||||||
| SARS-CoV-2, spike protein IgG, AU/mL (ref., 34-280) | — | — | — | 20.8 | — | — | — |
| SARS-CoV-2, nucleoprotein IgG (ref., <1.0) | — | — | — | <0.070 | — | — | — |
| Cytomegalovirus IgG/IgM | — | — | — | Pos/neg | — | — | — |
| Ebstein-Barr virus IgG/IgM | — | — | — | Pos/neg | — | — | — |
| Hepatitis A, hepatitis B s-Ab/s-Ag, hepatitis C | — | — | — | Neg | — | — | — |
| HIV1 and HIV2 (Ag+Ab) | — | — | — | Neg | — | — | — |
| Parvovirus B19 IgG /IgM | — | — | — | Pos/neg | — | — | — |
| Polymerase chain reaction | |||||||
| SARS-CoV-2 (oropharyngeal swab) | — | Neg | — | Neg | — | — | — |
| Influenza type A+B, adenovirus, metapneumovirus, parainfluenza, respiratory syncytial virus and rhinovirus (oropharyngeal swab) | — | — | — | Neg | — | — | — |
| Bacterial and viral meningitis panel (cerebrospinal fluid)† | — | Neg | — | — | — | — | — |
| Immunology | |||||||
| C3, g/L (ref., 0.811-1.570) | — | — | — | 1.42 | — | — | — |
| C4, g/L (ref., 0.129-0.392) | — | — | — | 0.345 | — | — | — |
| Antinuclear IgG (ref., <0.1) | — | — | — | 0.1 | — | — | — |
| Anti–double-stranded DNA IgG, kIU/L (ref., < 10) | — | — | — | 3.7 | — | — | — |
| Anti-Smith, anti-(U1) snRNP, anti-SSA, anti-SSB, anti-scl-70, anti-Jo1, anti-MPO, anti-PR3, anti-glomerular basement membrane, and immunoglobulin G | — | — | — | Neg | — | — | — |
| . | 11 . | 14 . | 15 . | 16 . | 17 . | 18 . | 19 . |
|---|---|---|---|---|---|---|---|
| Hematology | |||||||
| Hemoglobin, g/dL (ref., 11.8-15.3) | 13.4 | 13.9 | 13.7 | 12.3 | 11.6 | 11.5 | 10.8 |
| Platelets, ×109/L (ref., 145-390) | 57 | 56 | 70 | 88 | 119 | 159 | 187 |
| Platelets, citrate, ×109/L (ref., 145-390) | 39 | 46 | |||||
| Leukocytes, ×109/L (ref., 3.-8.8) | 11.0 | 11.0 | 11.0 | 10.3 | 12.1 | 10.1 | 9.1 |
| Basophils, ×109/L (ref., 0.01-0.10) | 0.05 | 0.07 | 0.07 | 0.11 | 0.06 | — | — |
| Eosinophils, ×109/L (ref., 0.01-0.5) | 0.27 | 0.20 | 0.36 | 0.51 | 0.71 | — | — |
| Monocytes, ×109/L (ref., 0.2-0,80) | 0.98 | 0.71 | 1.13 | 1.10 | 0.88 | — | — |
| Neutrophils, ×109/L (ref., 1.6-5.9) | 6.25 | 4.51 | 4.45 | 6.10 | 4.02 | — | — |
| Lymphocytes, ×109/L (ref., 1.0-3.5) | 3.42 | 5.61 | 4.99 | 4.93 | 5.26 | — | — |
| D-dimer, mg/L FEU (ref., <0.5) | — | >20 | 12 | 5.9 | 4.1 | 1.6 | 1.2 |
| CRP, mg/L (ref., <10) | 36 | 19 | 14 | 18 | 21 | 26 | 22 |
| Hemostasis | |||||||
| INR | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | 1.1 | 1.0 |
| Clotting factors II, VII, X (ref., >0.60) | 0.91 | 1.01 | 1.11 | 1.05 | 0.99 | 0.90 | 0.97 |
| aPTT, s (ref., 25-37) | — | 38 | 39 | 36 | 38 | 40 | 43 |
| Plasma fibrinogen, mg/dL (ref., 180-350) | — | 78 | 85 | 139 | 176 | 244 | 244 |
| ADAMTS13 protein, kIU/L (ref., 0.61-1.31) | — | — | — | 1.07 | — | — | — |
| Thrombophilia | |||||||
| Homocysteine, μmol/L (ref., <15.0) | — | — | — | 6.2 | — | — | — |
| Antithrombin, ×103IU/L (ref., 0.83-1.15) | — | 0.99 | 1.03 | 0.95 | 1.04 | 1.13 | 1.12 |
| Protein C, ×103 IU/L (ref., 0.70-1.30) | — | — | — | 1.20 | — | — | — |
| Protein S, ×103 IU/L (ref., 0.57-1.30) | — | — | — | 0.85 | — | — | — |
| Factor V Leiden R506Q mutation | — | — | — | Not detected | — | — | — |
| Prothrombin gene mutation (G20210A) | — | — | — | Heterozygous | — | — | — |
| Lupus anticoagulant | — | — | — | NA* | — | — | — |
| Cardiolipin IgG/IgM, ×103 IU/L (ref., <10.0) | — | — | — | 2.2/2.5 | — | — | — |
| β-2-GP1 IgG/IgM, kU/L (ref., 0-10) | — | — | — | <0.6 /<0.9 | — | — | — |
| Organ marker | |||||||
| ALT, U/L (ref., 10-45) | 29 | 61 | — | 134 | 123 | 115 | 95 |
| Serology | |||||||
| SARS-CoV-2, spike protein IgG, AU/mL (ref., 34-280) | — | — | — | 20.8 | — | — | — |
| SARS-CoV-2, nucleoprotein IgG (ref., <1.0) | — | — | — | <0.070 | — | — | — |
| Cytomegalovirus IgG/IgM | — | — | — | Pos/neg | — | — | — |
| Ebstein-Barr virus IgG/IgM | — | — | — | Pos/neg | — | — | — |
| Hepatitis A, hepatitis B s-Ab/s-Ag, hepatitis C | — | — | — | Neg | — | — | — |
| HIV1 and HIV2 (Ag+Ab) | — | — | — | Neg | — | — | — |
| Parvovirus B19 IgG /IgM | — | — | — | Pos/neg | — | — | — |
| Polymerase chain reaction | |||||||
| SARS-CoV-2 (oropharyngeal swab) | — | Neg | — | Neg | — | — | — |
| Influenza type A+B, adenovirus, metapneumovirus, parainfluenza, respiratory syncytial virus and rhinovirus (oropharyngeal swab) | — | — | — | Neg | — | — | — |
| Bacterial and viral meningitis panel (cerebrospinal fluid)† | — | Neg | — | — | — | — | — |
| Immunology | |||||||
| C3, g/L (ref., 0.811-1.570) | — | — | — | 1.42 | — | — | — |
| C4, g/L (ref., 0.129-0.392) | — | — | — | 0.345 | — | — | — |
| Antinuclear IgG (ref., <0.1) | — | — | — | 0.1 | — | — | — |
| Anti–double-stranded DNA IgG, kIU/L (ref., < 10) | — | — | — | 3.7 | — | — | — |
| Anti-Smith, anti-(U1) snRNP, anti-SSA, anti-SSB, anti-scl-70, anti-Jo1, anti-MPO, anti-PR3, anti-glomerular basement membrane, and immunoglobulin G | — | — | — | Neg | — | — | — |
Ab, antibody, Ag, antigen; ALT, alanine aminotransferase; anti-MPO, anti-myeloperoxidase; anti-PR3, anti-proteinase 3; aPTT, activated partial thromboplastin time; CRP, C-reactive protein; FEU, fibrinogen equivalent units; INR, international normalized ratio; PCR, polymerase chain reaction; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
Lupus anticoagulant could not be assessed because of the heparinization of the blood.
No growth on cultures, and PCR testing for a panel of 14 pathogens was negative (BioFire FilmArray Meningitis-Encephalitis (ME) Panel; bioMérieux).