Thrombocytopenia and Thrombosis

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Introduction: Our interest in this topic was also provoked by observations and reports, from our and other cases, of thrombosis caused by vaccines against COVID-19 by polyvalent anti-COVID-therapy. Aim: We set ourselves the goal of presenting to the scientific audience our hypothesis about the occurrence of thrombosis after vaccination against COVID-19 or polyvalent anti-COVID therapy, as well as the mechanism of response in the treatment of patients with COVID-19 by plasma replacement therapy—either from recovered or healthy people. Tasks: To achieve this goal, we summarized the laboratory data of our patients, as well as the literature available to us on this issue. Material: We used CBC blood tests, coagulation status and biochemical markers of patients. Method: We compared the laboratory changes found by us with those indicated in the scientific literature. Results and Discussion: Based on the analyzed cases and the data provided in the scientific literature, we formulated our hypothesis about the mechanism of abnormal platelet reactivity to COVID-19 vaccines and polytherapeutic regimens in this disease, as well as our hypothesis for the treatment of patients with COVID-19 by plasma replacement therapy. Conclusion: According to our hypothesis, thrombosis during vaccination or polytherapy of COVID-19 is due to inactivation of the enzyme eADAMTS-13 and formation of thromboembryonic macromultimers of von Willebrand (vWF) factor by the mechanism of microcirculatory hyaline thrombosis in the pathogenesis of the acquired form of thrombotic thrombopenic purpura (TTP). The positive effect of plasma replacement therapy in patients with COVID-19 is based rather on dilution of defectively formed ultra-large vWF multimers and physiological substitution of the active enzyme eADAMTS-13, which is confirmed by the rapidly occurring clinical improvement in patients treated in this way, than on an Ag-At reaction the effect of which requires a longer period of time and which reaction is used in medicine as a prophylaxis, rather than a curative purpose.