Anti-PF4 mediated thrombocytopenia and thrombosis associated with acute cytomegalovirus infection displays both HIT-like and VITT-like characteristics
Nicolson, Phillip L R Montague, Samantha J Buka, Richard J Calvert, Anthony Sheppard, Jo-Ann I Zhang, Yi Wang, Jing Jing Sharman, Jack Hassan, Eman Harrison, James
Nicolson, Phillip L R
Montague, Samantha J
Buka, Richard J
Calvert, Anthony
Sheppard, Jo-Ann I
Zhang, Yi
Wang, Jing Jing
Sharman, Jack
Hassan, Eman
Harrison, James
Affiliation
University Hospitals Birmingham NHS Foundation Trust; University of Birmingham; NHS Blood and Transplant; McMaster University; Flinders University; Flinders Medical Centre; Hamilton Health Sciences
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Publication date
2025-04-29
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Abstract
Vaccine-induced immune thrombocytopenia and thrombosis (VITT) is one of several anti-platelet factor 4 (anti-PF4)-associated immune thrombocytopenia and thrombosis (PITT) syndromes. As well as following adenoviral vector vaccines, VITT has recently been described following acute adenovirus infection. We describe a patient with PITT following acute cytomegalovirus infection. The antibody clonotype and PF4 epitopes were distinct from those identified in VITT, and they were detectable as a paraprotein. PITT should be considered in all patients with thrombocytopenia and thrombosis, even without preceding vaccination or heparin, but who otherwise meet the VITT criteria defined by the British Society of Haematology Expert Panel.
Citation
Nicolson PLR, Montague SJ, Buka RJ, Calvert A, Sheppard JI, Zhang Y, Wang JJ, Sharman J, Hassan E, Harrison J, Lawrence E, El-Dalil P, Parekh D, Osman H, Gordon TP, Nazy I, Warkentin TE, Lester WA. Anti-PF4 mediated thrombocytopenia and thrombosis associated with acute cytomegalovirus infection displays both HIT-like and VITT-like characteristics. Br J Haematol. 2025 Jun;206(6):1737-1742. doi: 10.1111/bjh.20092. Epub 2025 Apr 29.
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