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Dosing of intravenous immunoglobulin in COVID-19 vaccine-induced immune thrombocytopenia and thrombosis
  1. Siraj A Misbah1,
  2. Sue Pavord2,
  3. Mark Foster3
  1. 1 Clinical Immunology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  2. 2 Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  3. 3 Haematology, Medical Data Solutions and Services (MDSAS), Manchester, UK
  1. Correspondence to Dr Siraj A Misbah, Immunology, Oxford University Hospitals NHS Foundation Trust, OX3 9DU, Oxford, UK; siraj.misbah{at}

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Vaccine-induced immune thrombocytopenia and thrombosis (VITT) is now a well-recognised, but rare serious complication of adenoviral vectored vaccines against SARS-CoV-2, with an incidence of 14.9 per million of first dose of ChAdOx1 nCoV-19 vaccine.1 Based on its clinical and immunological similarities with heparin-induced thrombocytopenia (HIT), early treatment with high-dose intravenous immunoglobulin (IVIg) along with anticoagulation was recommended by the Expert Haematology Panel in March 20212 and supported by the National Institute for Health Care Excellence.3

IVIg is itself prothrombotic and hence optimal dose selection is crucial, to avoid aggravating an intensely prothrombotic disorder. Observation of new thromboses has added to this concern.4 Using data from the UK Biobank, Kapoor and colleagues demonstrated that exposure to IVIg was associated with an increased risk of thromboembolic events (TEEs) of 8.7% in patients with a history of …

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  • Handling editor Tahir S Pillay.

  • Contributors SAM conceived and wrote the first draft of the manuscript. SP critically reviewed and revised the manuscript. MF provided and validated data on immunoglobulin use in VITT.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests SAM chairs the immunoglobulin expert working group at NHS England.

  • Provenance and peer review Not commissioned; externally peer reviewed.