21 Exciting Hematological Case Reports

Demonstrating the amazing strong durable potent mild transient safe & effective immune response elicited by the wunderjabs

Many of the 2,360+ and counting case reports are extra noteworthy for a variety of reasons. The following are hematological case reports that have a little extra something on top, organized into the following categories:

• Yikes!! Avalanche of Clots / Injuries - Clots here, clots there, clots everywhere. Oh, and some other goodies too. More than enough spike protein for all parts of the anatomy to help themselves.

• Hard Evidence That Vaccine Killed the Fetus - and then killed the mother too.

• Ignorance Abounds - Take it from their own admissions.

• Sheer Quantity - When your hospital gets deluged by VITT’s

• Long Term - The promised transient-ness of your vaccine injury turns out to have been a transient promise by the medical authorities.

• Consequences of Denialism - A surprisingly explicit take on what happens when ostriches are in charge of public health.

(Note: The number for each study before the study title is from the Compilation of 195 Case Reports Documenting 386 Vaccine Associated Hematological Injuries.)

Previous installation in this series:

27 Noteworthy Myocarditis Case Studies

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Yikes!! Avalanche of Clots / Injuries

159: Myocarditis, Pulmonary Hemorrhage, and Extensive Myositis with Rhabdomyolysis 12 Days After First Dose of Pfizer-BioNTech BNT162b2 mRNA COVID-19 Vaccine: A Case Report

Link: https://pubmed.ncbi.nlm.nih.gov/35173141/

Diagnoses: TCP, Myo, PH, Myositosis, Rhabdomyolysis

Case: “A 37-year-old man presented to the Emergency Department (ED) with a 3-day history of back pain and a 1-day history of left upper limb swelling with paresthesia and shortness of breath, 12-days after receiving the first dose of Pfizer/BioNTech BNT162b2 mRNA COVID-19 vaccine. He was diagnosed with severe myositis complicated with rhabdomyolysis and non-oliguric acute kidney injury, thrombocytopenia, myocarditis with pulmonary edema, and pulmonary hemorrhage. Screens for potential toxic, infectious, paraneoplastic, and autoimmune disorders were unremarkable. The patient was treated with a 5-day course of intravenous methylprednisolone and intravenous immunoglobulin, with a good response. He was hospitalized for 16 days and discharged home on a tapering dose of oral prednisolone for 6 weeks.”

“The case describes a possible link between Pfizer/BioNTech BNT162b2 mRNA COVID-19 vaccine and immune-mediated myocarditis, pulmonary vasculitis, myositis, and thrombocytopenia. However, further data are required to confirm such an association.”

50: Case Report of Clot from mRNA Vaccine: Thrombosis With Thrombocytopenia After the Messenger RNA–1273 Vaccine | Annals of Internal Medicine

Link: https://www.acpjournals.org/doi/10.7326/L21-0244

Diagnoses: VITT, TTS, DVT, PE, MT, CVST, TCP, AGH

Case: “He was diagnosed with severe myositis complicated with rhabdomyolysis and non-oliguric acute kidney injury, thrombocytopenia, myocarditis with pulmonary edema, and pulmonary hemorrhage.

A computed tomography angiogram of the chest showed large, bilateral, acute pulmonary emboli with right ventricular strain. Doppler studies of the lower extremities revealed acute deep venous thromboses in both lower extremities. The patient had severe thrombocytopenia (14 × 109 cells/L) (Table and Figure) (171 × 109 cells/L had been documented 18 months earlier).

Three days later, the patient developed an acute gluteal hematoma requiring withdrawal of heparin.

“The case describes a possible link between Pfizer/BioNTech BNT162b2 mRNA COVID-19 vaccine and immune-mediated myocarditis, pulmonary vasculitis, myositis, and thrombocytopenia. However, further data are required to confirm such an association.”

13: A Rare Case of Cerebral Venous Thrombosis and Disseminated Intravascular Coagulation Temporally Associated to the COVID-19 Vaccine Administration - PubMed

Link: https://pubmed.ncbi.nlm.nih.gov/33917902/

Case: “We report the case of a 54-year-old woman who developed disseminated intravascular coagulation (DIC) with multi-district thrombosis 12 days after the AstraZeneca COVID-19 vaccine administration. A brain computed tomography (CT) scan showed multiple subacute intra-axial hemorrhages in atypical locations, including the right frontal and the temporal lobes. A plain old balloon angioplasty (POBA) of the right coronary artery was performed, without stent implantation, with restoration of distal flow, but with persistence of extensive thrombosis of the vessel. A successive thorax angio-CT added the findings of multiple contrast filling defects with multi-vessel involvement: at the level of the left upper lobe segmental branches, of left interlobar artery, of the right middle lobe segmental branches and of the right interlobar artery. A brain magnetic resonance imaging (MRI) in the same day showed the presence of an acute basilar thrombosis associated with the superior sagittal sinus thrombosis. An abdomen angio-CT showed filling defects at the level of left portal branch and at the level of right suprahepatic vein. Bilaterally, it was adrenal hemorrhage and blood in the pelvis. An evaluation of coagulation factors did not show genetic alterations so as the nasopharyngeal swab ruled out a COVID-19 infection. The patient died after 5 days of hospitalization in intensive care.”

146: Acute ST-Segment Elevation Myocardial Infarction After ChAdOx1 nCoV-19 Vaccination in a 33-Year-Old Man

Link: https://pubmed.ncbi.nlm.nih.gov/35065747/

Diagnoses: vaccine-induced thrombotic thrombocytopenia, thrombotic thrombocytopenia, cerebral venous sinus thrombosis, arterial thrombosis, myocardial injury, ischemic infarcts, Intracerebral Hemorrhage, coronary artery thrombosis, et al

Whole-body imaging studies with CT/MRI/MRA were done and disclosed multiple thrombi at the straight, left transverse cerebral venous sinuses down to the left internal jugular veins, subsegmental pulmonary arteries, descending aorta, and hepatic veins. Tiny ischemic infarcts in the right centrum semiovale and temporal cortex and segmental infarctions in the spleen were also found. His clinical course was very complicated, and his persistent thrombocytopenia, decreased fibrinogen level, and very high D-dimer level were refractory to treatment with intravenous immunoglobulin, methylprednisolone, a direct oral anticoagulant, and cryoprecipitate. A severe headache happened on day 7 of hospitalization. An emergency decompressive craniotomy was undertaken for an intracerebral hemorrhage in his left cerebrum, followed by a retrograde thrombectomy of his intracranial venous sinuses on the next day. His cardiac troponin level was elevated again on day 9. A total occlusion of the left circumflex artery at the ostium and heavy thrombi in the right coronary artery were disclosed and treated. Although his platelet count and fibrinogen and D-dimer levels began to improve with plasma exchanges, his condition deteriorated, he had multiple organ failures, and he succumbed on day 14 of hospitalization.

75: Vaccine-induced severe thrombotic thrombocytopenia following COVID-19 vaccination: a report of an autoptic case and review of the literature - PubMed

Link: https://pubmed.ncbi.nlm.nih.gov/34355379/

Diagnoses: VITT, MIT, MT, FT, PVT, TCP, CT

At histology, in the lungs, interalveolar septa appeared thickened with microthrombi in the capillaries and veins. Interalveolar septa appeared thickened and showed vascular proliferation. Thrombi were detected in the capillaries of glomerular tufts. In the hearth, thrombi were observed in veins and capillaries. In the liver, voluminous fibrin thrombi were diffusely observed in the branches of the portal vein. Microthrombi were also found in the vasa vasorum of the wall of abdominal aorta. In the brain, microthrombi were observed in the capillaries of the choroid plexuses. Diffuse hemorrhagic necrosis was observed in the intestinal wall with marked congestion of the venous vessels.

Extra Credit:

Platelet Count of *0* (!!)

178: BNT162b2 COVID-19 Vaccine Induced Immune Thrombocytopenic Purpura

Link: https://pubmed.ncbi.nlm.nih.gov/35464782/

Herein, we present a patient who presented with severe ITP with a platelet count of 0 after receiving the second dose of the BNT162b2 mRNA COVID-19 vaccine [..].

Covid Lung Destruction

147: Ultrastructural findings of lung injury due to Vaccine-induced Immune Thrombotic Thrombo- cytopenia (VITT) following COVID-19 vaccination: a scanning electron microscopic study

Link: https://pubmed.ncbi.nlm.nih.gov/35049004/

Alveoli were mainly dilated, irregular in shape, and occupied by a reticular network of fibrin, while interalveolar septa appeared thickened. The proliferation of small capillaries gave rise to plexiform structures and pulmonary capillary hemangiomatosis-like features. Near the alveoli occupied by a dense fibrin network, the medium-sized arteries showed a modified wall and an intraluminal thrombus. This scenario looks quite similar to that found during COVID-19, where the lungs suffer from the attack of the antigen-antibodies complexes and the virus respectively. In both diseases, the final outcome is a severe inflammation, activation of the haemostatic system and fibrinolysis.

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Hard Evidence That Vaccine Killed the Fetus

The following case report actually straight up admits that the placental vessels got whacked with clots. Obviously, clots in placental vessels is bad news for the clump of cells inside the placenta, which deprived of blood flow will shrivel up into an even smaller clump of cells that will thus never become more than a (really massive) clump of cells:

40: Intracerebral hemorrhage associated with vaccine-induced thrombotic thrombocytopenia following ChAdOx1 nCOVID-19 vaccine in a pregnant woman - PMC

Link: https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC8561298/

Besides that, thrombosis was observed in placental vessels.

The constellation of signs and symptoms suggests VITT diagnosis complicated by intracranial hemorrhage with a fatal outcome both to fetus and mother.

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Ignorance Abounds

121: Case Report: Vaccine-Induced Immune Thrombotic Thrombocytopenia in a Pancreatic Cancer Patient After Vaccination With Messenger RNA-1273 - PubMed

Link: https://pubmed.ncbi.nlm.nih.gov/34790684/

Vaccination plays an important role during the COVID-19 pandemic. Vaccine-induced thrombotic thrombocytopenia (VITT) is a major adverse effect that could be lethal. For cancer patients, cancer-related thromboembolism is another lethal complication. When cancer patients receive their COVID-19 vaccines, the following thromboembolic events will be more complicated.

The titer of anti-platelet factor four and d-dimer level decreased, but the patient ultimately died.

The complicated condition of VITT superimposed cancer-related thromboembolism was considered. To our knowledge, only one case of mRNA-1273 related VITT was reported, and this case study was the first to report a cancer patient who was diagnosed with VITT after mRNA-1273 vaccination. Therefore, when the need for vaccination among cancer patients increased under the current COVID-19 pandemic, the possible risk of VITT for cancer patients should be carefully managed. Further studies of the risk evaluation of the COVID-19 vaccine in cancer patients might be required in the future.

130: VITT following Ad26.COV2.S vaccination presenting without radiographically demonstrable thrombosis

Link: https://pubmed.ncbi.nlm.nih.gov/34587255/

To our knowledge, this is the first reported case of VITT following Ad26.COV2.S vaccination presenting without radiographically demonstrable thrombosis. Our patient highlights the importance of knowing vaccine status and initiating treatment as soon as possible in the right clinical setting, even in the absence of radiographic evidence of thrombus. Early VITT recognition and treatment provide an opportunity to prevent serious thrombotic complications.

141: Abrupt worsening of occult IgA nephropathy after the first dose of SARS-CoV-2 vaccination

Link: https://pubmed.ncbi.nlm.nih.gov/34988883/

We should pay more attention to the development/worsening of clinically significant kidney disease after SARS-CoV-2 vaccination not only in those with known glomerular disease but also in those with only mild urinary abnormality.

108: Immune thrombocytopenic purpura following administration of mRNA-based SARS-CoV-2 and MMR vaccinations: a cautionary tale

Link: https://pubmed.ncbi.nlm.nih.gov/34635874/

Although our patient's clinical presentation and subsequent course are similar to those of other cases of ITP in association with SARS-CoV-2 vaccination, to our knowledge, this is the first reported case of ITP following MMR and mRNA SARS-CoV-2 vaccine coadministration. It would be impossible to conclusively prove that the patient's thrombocytopenia was secondary to the SARS-CoV-2 vaccine alone, the MMR vaccine, or an additive effect of both vaccines. However, with the CDC guidelines recommending the coadministration of the mRNA SARS-CoV-2 vaccine without regards to timing with other vaccines, we urge further caution as there is limited evidence to inform practice. This case highlights the need for further safety data regarding the coadministration and timing of the mRNA SARS-CoV-2 vaccine with other vaccines.”

139: Vaccine-induced massive pulmonary embolism and thrombocytopenia following a single dose of Janssen Ad26.COV2.S vaccination

Link: https://pubmed.ncbi.nlm.nih.gov/34986404/

Treatment with intravenous immunoglobulin, however, could mask the ability of anti-platelet factor 4-heparin antibodies to bind and activate platelets in the presence of heparin, leading to false-negative results on the immunoassay functional test. Therefore, if VITT is suspected, blood samples for diagnostic confirmation should be collected prior to any treatment to improve diagnostic performance.

107: An unusual presentation of acute deep vein thrombosis after the Moderna COVID-19 vaccine-a case report - PubMed

Link: https://pubmed.ncbi.nlm.nih.gov/34790811/

Considering our case did not have any evidence of thrombocytopenia, we discuss the possible pathophysiology of acute DVT following Moderna COVID-19 vaccine in contrast to adenoviral vector COVID-19 vaccines (ChAdOx1 nCoV-19 and Ad26.COV2.S), including mRNA COVID-19 vaccine binding to pattern recognition receptors (PRR) in the endosomes and cytosol leading to a pro inflammatory cascade and coagulopathy.

Extra Credit:

J&J Trial Investigator Blew Off VITT:

15: Thrombotic Thrombocytopenia after Ad26.COV2.S Vaccination

Link: https://pubmed.ncbi.nlm.nih.gov/33852795/

We note with interest that during the clinical evaluation of the Ad26.COV2.S vaccine, a 25-year-old man was found to have symptomatic transverse sinus thrombosis beginning 19 days after vaccination. Although the case investigation and expert opinion deemed this event to be unrelated to the vaccine,5 this finding may require reevaluation in light of our patient’s clinical course. Unlike the Pfizer–BioNTech and Moderna vaccines, which are messenger RNA–based, the ChAdOx1 nCov-19 and Ad26.COV2.S vaccines are nonreplicating adenovirus vector–based DNA vaccines. Our case suggests that the rare occurrence of vaccine-induced immune thrombotic thrombocytopenia could be related to adenoviral vector vaccines.

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Sheer Quantity

69: Vaccine Induced Immune Thrombotic Thrombocytopenia Causing a Severe Form of Cerebral Venous Thrombosis With High Fatality Rate: A Case Series - PubMed

Link: https://pubmed.ncbi.nlm.nih.gov/34393988/

During a 2-week period, we have encountered five cases presenting with the combination of cerebral venous thrombosis (CVT), intracerebral hemorrhage and thrombocytopenia. A clinical hallmark was the rapid and severe progression of disease in spite of maximum treatment efforts, resulting in fatal outcome in for 4 out of 5 patients. All cases had received ChAdOx1 nCov-19 vaccine 1-2 weeks earlier and developed a characteristic syndrome thereafter.

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Long Term

128: Complicated Long Term Vaccine Induced Thrombotic Immune Thrombocytopenia-A Case Report - PubMed

Link: https://pubmed.ncbi.nlm.nih.gov/34835275/

The patient presented with extended superior sagittal sinus thrombosis with accompanying bifrontal intracerebral hemorrhage. Repeated treatment with intravenous immune globuline (IVIG) resolved recurrent episodes of thrombocytopenia. Moreover, the patient's serum remained strongly positive for platelet-activating anti-PF4-IgG over three months. After a period of clinical stabilization, the patient suffered a recurrent and fatal intracranial hemorrhage.

144: Combined Central Retinal Artery and Vein Occlusion with Ischemic Optic Neuropathy After COVID-19 Vaccination

Link: https://pubmed.ncbi.nlm.nih.gov/35079224/

“While the patient recovered 20/30 vision, he continued to note light and color desaturation and exhibited a 2+ relative afferent pupillary defect in the left eye. The most recent RNFL study demonstrated nerve fiber layer loss in the superior pole of the nerve consistent with the diagnosis of NAION. There was also a residual inferior altitudinal visual field defect (Figure 4).”

135: First diagnosis of thrombotic thrombocytopenic purpura after SARS-CoV-2 vaccine - case report

Link: https://pubmed.ncbi.nlm.nih.gov/34895163/

One month after the initial presentation, the patient is in good overall condition, but still receives daily caplacizumab due to ADAMTS-13 activity of < 1%.

82: A rare case of vaccine-induced immune thrombosis and thrombocytopenia and approach to management

Link: https://pubmed.ncbi.nlm.nih.gov/34513173/

Although she was left with long-term neurological deficits, an early presentation and a multidisciplinary approach to management contributed toward a relatively short stay in hospital and avoided mortality.

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Consequences of Denialism

31: Oxford-AstraZeneca COVID-19 vaccine-induced cerebral venous thrombosis and thrombocytopaenia: A missed opportunity for a rapid return of experience - ScienceDirect

Link: https://www.sciencedirect.com/science/article/pii/S235255682100093X

We were aware of the possibility of cerebral venous thrombosis after COVID-19 vaccination, and the declaration to our regional pharmacovigilance centre was made on the 23rd of March 2021. We would like, however, to share the difficulties we had to find reliable clinical information in this context.

Our knowledge of the pathophysiology and therapeutic possibilities was very limited.

This was the only reliable information we had at this time. Without information and feedback from similar cases, we felt like engaging in shady dealings without really understanding the pathophysiological processes of the disease and the risks/benefits balance of therapeutic options.

We believe that an early exchange between clinicians who reported similar events would have been very useful. Organising such a rapid online feedback, focusing on bedside experiences of clinicians facing similar critical situations would have probably avoided the pitfalls of a new and poorly known disease.

Professional networks, sometimes linked to scientific societies, can probably contribute a lot by allowing contact between physicians, quickly drafting guidelines and disseminating them through their usual network. They are however highly dependent on effective early warning systems.

We propose that, in the case of serious and life-threatening conditions, pharmacovigilance agencies, in addition to collecting and analysing serious events, should propose the possibility of a rapid contact between clinicians who have reported similar events via an exchange of e-mail addresses or the creation of discussion forums, on a global and international scale. As publication process for original articles and guidelines requires several weeks, this rapid feedback and sharing of information seem essential in such situations with new, serious, life-threatening and potentially frequent adverse events, for which the scientific knowledge and clinical experience are very limited.

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