Rare Thrombosis Research Articles

Distinct platelet crosstalk with adaptive and innate immune cells after adenoviral and mRNA vaccination against SARS-CoV-2

BackgroundGenetic-based COVID-19 vaccines have proved to be highly effective in reducing the risk of hospitalization and death. Because they were first distributed in a large-scale population, the adenoviral-based vaccines were linked to a very rare thrombosis with thrombocytopenia syndrome, and the interplay between platelets and vaccinations increasingly gained attention. ObjectivesThe objective of this article was to study the crosstalk between platelets and the vaccine-induced immune response. MethodsWe prospectively enrolled young healthy volunteers who received the mRNA-based vaccine, BNT162b2 (n = 15), or the adenovirus-based vaccine, AZD1222 (n = 25) and studied their short-term platelet and immune response before and after vaccine injections. In a separate cohort, we retrospectively analyzed the effect of aspirin on the antibody response 1 and 5 months after BNT162b2 vaccination. ResultsHere, we show that a faster antibody response to either vaccine is associated with the formation of platelet aggregates with marginal zone-like B cells, a subset geared to bridge the temporal gap between innate and adaptive immunities. However, although the mRNA-based vaccine is associated with a more gradual and tolerogenic response that fosters the crosstalk between platelets and adaptive immunity, the adenovirus-based vaccine, the less immunogenic of the 2, evokes an antiviral-like response during which the platelets are cleared and less likely to cooperate with B cells. Moreover, subjects taking aspirin (n = 56) display lower antibody levels after BNT162b2 vaccination compared with matched individuals. ConclusionPlatelets are a component of the innate immune pathways that promote the B-cell response after vaccination. Future studies on the platelet-immune crosstalk post-immunization will improve the safety, efficacy, and strategic administration of next-generation vaccines.

Septic Cavernous Sinus Thrombosis (CST) with Blindness Caused by Odontogenic Infection – A Case Report

Introduction: Septic cavernous sinus thrombosis (CST) is a rare thrombosis, but severe, causing damage to all nerves inside the cavernous sinus. The incidence rate of CST is estimated at two to four per million people per year. The symptom usually varies, gradually worsening, making diagnosis harder and potentially making permanent disability. Early detection and prompt treatment are very important to lower the morbidity rate. Case: Tn. M had complained of multiple headaches attacks since 8 months ago before being admitted followed by diplopia. Complaints had worsened 3 months before with the loss of vision in the left eye. MRI showed left thrombosis sinus cavernous. The terrible headache was scaled 8-9 with VAS score. The patient’s left eye was found proptosis palpebra, with anisocoria and mydriasis followed by no direct light reflex also indirect light reflex, visual acuity of the left eye is no light response, whereas the patient’s right eye is normal. On the patient’s left eye was found gaze palsy sinistra. The abnormal blood result was leucocytosis and thrombocytosis. The patient was given fondaparinux once a day with a dose of 6000 units subcutaneously for 5 days. After that, the headache was decreased significantly. The patient underwent 5 tooth extraction done by mouth surgeon after being discharged. The patient was given 20 mg rivaroxaban per day for three weeks, then 10mg per day for three months, and evaluated with MRV again. Conclusion: CST is still very rare but very lethal and makes permanent disability on the patient. Through this case, we demonstrate the potential of tooth infection which leads to septic CST and caused ophthalmoplegia and blindness.