Rare cases of blood clot and low platelets after receipt of adenovirus vector COVID-19 vaccines have been reported and are referred as VITT or Thrombosis with Thrombocytopenia Syndrome (TTS).
Till now seven such cases have been reported and confirmed by Sir Ganga Ram Hospital. Cases have been reported since early 2021 from Denmark, United Kingdom, Germany and Canada and on 11th August 2021 the UN issued guidelines for diagnosis and management of TTS.
In Our country first case of Vaccine Induced Thrombotic Thrombocytopenia (VITT) referred from Army Hospital R&R which was diagnosed and confirmed in June 2021 by Department of Hematology, Sir Ganga Ram Hospital under Dr (Prof) Jyoti Kotwal which has been published in Indian Journal of hematology and blood transfusion on 29 September 2021. Unfortunately due to late referral, the patient could not survive.
According to Dr. (Prof.) Jyoti Kotwal, Chairperson, Department of Hematology, Sir Ganga Ram Hospital, “Since the Index case of June 2021, we have received and diagnosed six more samples of VITT. Interestingly, five samples came from Kerala and one from neighboring hospitals of Delhi.” These samples came by courier to Sir Ganga Ram Hospital and due to timely diagnosis and advise for therapy the lives of all other patients of VITT could be saved.
The *gold standard* confirmatory test is presence of heparin dependant platelet aggregation of normal platelets by patient’s serum in presence of low dose of heparin. *The Hematology Department at Sir Ganga Ram Hospital under Professor Jyoti Kotwal is the only centre in India doing the gold standard Platelet aggregation test in the country. The samples of serum of suspected VITT are being received through courier and prompt diagnosis is made within 48 hours of receiving samples.
The diagnosis is suspected if symptoms occur between day 3 to day 30 of vaccination and there is thrombocytopenia. Further if d-dimer is raised and PF heparin antibody (HPF4 IgG) is present one can make a presumptive diagnosis.
The incidence reported from world is 1 in 100,000 to 1 in 127,000 vaccine doses. Sir Ganga Ram Hospital is the only centre in the country doing the confirmatory test for diagnosis of VITT.
Awareness of the symptoms, diagnostic and confirmatory tests and the treatment of VITT is the need of the hour. Germany, UK and Canada issued diagnostic and treatment guidelines and later in August 2021, the WHO has issued guidelines for the same. The incidence reported Sir Ganga Ram hospital has being doing the diagnostic and confirmatory test since June 2021 and is referral centre which has since confirmed 7 cases of vaccine induced thrombotic thrombocytopenia.