Abstract：
Corona virus disease 2019 (COVID-19) due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has affected the whole world. Acquired thrombotic thrombocytopenic purpura (TTP) has been reported after administration of mRNA- or adenoviral vector-based COVID-19 vaccines, including Ad26.COV2-S, BNT162b2, mRNA-1273, and ChAdOx1 nCov-19. However, whether inactivated vaccines, such as CoronaVac, could cause TTP and whether the symptoms in TTPs caused by inactivated vaccines are different from previously reported cases are unknown. In this study, two cases were reported. Both cases developed TTP after the second CoronaVac vaccination shot, but not the first. They demonstrated symptoms of fever, neurological abnormalities, renal dysfunction, thrombocytopenia, and hemolysis. Both patients achieved complete remission through several sessions of plasma exchanges and immune suppression. The incidence of TTP in Nanjing area was analyzed. The number of patients with TTP was 12 in 2019, 6 in 2020, 16 in 2021, and 19 in 2022. To the authors\' knowledge, this report is the first report of TTP associated with inactivated COVID-19 vaccine (CoronaVac). The rarity and delayed onset may be due to the relatively milder immune response caused by the inactivated vaccines than mRNA-based ones. Timely plasma exchange is a vital treatment for CoronaVac-related TTP, similar to activated vaccine-related TTP.
摘要：
由于严重急性呼吸道综合症冠状病毒2（SARS-CoV-2）感染，2019年冠状病毒病（COVID-19）影响了整个世界。已经报道了获得性血栓性血小板减少性紫癜（TTP）在施用基于mRNA或腺病毒载体的COVID-19疫苗后，包括Ad26。COV2-S,BNT162b2、mRNA-1273和ChAdOx1nCov-19。然而,无论是灭活疫苗，比如CoronaVac,可能导致TTP以及灭活疫苗引起的TTP症状是否与以前报道的病例不同尚不清楚。在这项研究中,报告了两例。这两个病例在第二次注射CoronaVac疫苗后出现TTP，但不是第一个。他们表现出发烧的症状，神经异常,肾功能不全,血小板减少症,和溶血。两名患者通过几次血浆置换和免疫抑制均达到完全缓解。分析南京地区TTP的发病情况。2019年TTP患者人数为12人，2020年为6人，2021年为16人，2022年为19人。就作者所知，本报告是与灭活COVID-19疫苗（CoronaVac）相关的TTP的第一份报告。稀有和延迟发作可能是由于灭活疫苗引起的免疫反应比基于mRNA的疫苗相对温和。及时血浆置换是CoronaVac相关TTP的重要治疗方法，与活疫苗相关的TTP相似。
