Anti-PF4 mediated thrombocytopenia and thrombosis associated with acute cytomegalovirus infection displays both HIT-like and VITT-like characteristics

Phillip L.R. Nicolson; Samantha J. Montague; Richard J. Buka; Anthony Calvert; Jo Ann I. Sheppard; Yi Zhang; Jing Jing Wang; Jack Sharman; Eman Hassan; James Harrison; Errin Lawrence; Phillip El-Dalil; Dhruv Parekh; Husam Osman; Tom P. Gordon; Ishac Nazy; Theodore E. Warkentin; Will A. Lester

doi:10.1111/bjh.20092

Anti-PF4 mediated thrombocytopenia and thrombosis associated with acute cytomegalovirus infection displays both HIT-like and VITT-like characteristics

Phillip L.R. Nicolson, Samantha J. Montague, Richard J. Buka, Anthony Calvert, Jo Ann I. Sheppard, Yi Zhang, Jing Jing Wang, Jack Sharman, Eman Hassan, James Harrison, Errin Lawrence, Phillip El-Dalil, Dhruv Parekh, Husam Osman, Tom P. Gordon, Ishac Nazy, Theodore E. Warkentin, Will A. Lester

College of Medicine and Public Health

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Abstract

Vaccine-induced immune thrombocytopenia and thrombosis (VITT) is one of several anti-platelet factor 4 (anti-PF4)-associated immune thrombocytopenia and thrombosis (PITT) syndromes. As well as following adenoviral vector vaccines, VITT has recently been described following acute adenovirus infection. We describe a patient with PITT following acute cytomegalovirus infection. The antibody clonotype and PF4 epitopes were distinct from those identified in VITT, and they were detectable as a paraprotein. PITT should be considered in all patients with thrombocytopenia and thrombosis, even without preceding vaccination or heparin, but who otherwise meet the VITT criteria defined by the British Society of Haematology Expert Panel.

Original language	English
Pages (from-to)	1737-1742
Number of pages	6
Journal	British Journal of Haematology
Volume	206
Issue number	6
Early online date	29 Apr 2025
DOIs	https://doi.org/10.1111/bjh.20092
Publication status	Published - Jun 2025

Keywords

cytomegalovirus
FCY receptor
heparin-induced TP
monoclonal antibodies
platelet activation
platelet factor 4
thrombocytopenia
thrombosis

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Nicolson, P. L. R., Montague, S. J., Buka, R. J., Calvert, A., Sheppard, J. A. I., Zhang, Y., Wang, J. J., Sharman, J., Hassan, E., Harrison, J., Lawrence, E., El-Dalil, P., Parekh, D., Osman, H., Gordon, T. P., Nazy, I., Warkentin, T. E., & Lester, W. A. (2025). Anti-PF4 mediated thrombocytopenia and thrombosis associated with acute cytomegalovirus infection displays both HIT-like and VITT-like characteristics. British Journal of Haematology, 206(6), 1737-1742. https://doi.org/10.1111/bjh.20092

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title = "Anti-PF4 mediated thrombocytopenia and thrombosis associated with acute cytomegalovirus infection displays both HIT-like and VITT-like characteristics",

abstract = "Vaccine-induced immune thrombocytopenia and thrombosis (VITT) is one of several anti-platelet factor 4 (anti-PF4)-associated immune thrombocytopenia and thrombosis (PITT) syndromes. As well as following adenoviral vector vaccines, VITT has recently been described following acute adenovirus infection. We describe a patient with PITT following acute cytomegalovirus infection. The antibody clonotype and PF4 epitopes were distinct from those identified in VITT, and they were detectable as a paraprotein. PITT should be considered in all patients with thrombocytopenia and thrombosis, even without preceding vaccination or heparin, but who otherwise meet the VITT criteria defined by the British Society of Haematology Expert Panel.",

keywords = "cytomegalovirus, FCY receptor, heparin-induced TP, monoclonal antibodies, platelet activation, platelet factor 4, thrombocytopenia, thrombosis",

author = "Nicolson, {Phillip L.R.} and Montague, {Samantha J.} and Buka, {Richard J.} and Anthony Calvert and Sheppard, {Jo Ann I.} and Yi Zhang and Wang, {Jing Jing} and Jack Sharman and Eman Hassan and James Harrison and Errin Lawrence and Phillip El-Dalil and Dhruv Parekh and Husam Osman and Gordon, {Tom P.} and Ishac Nazy and Warkentin, {Theodore E.} and Lester, {Will A.}",

year = "2025",

month = jun,

doi = "10.1111/bjh.20092",

language = "English",

volume = "206",

pages = "1737--1742",

journal = "British Journal of Haematology",

issn = "0007-1048",

publisher = "BLACKWELL PUBLISHERS INC",

number = "6",

}

Nicolson, PLR, Montague, SJ, Buka, RJ, Calvert, A, Sheppard, JAI, Zhang, Y, Wang, JJ, Sharman, J, Hassan, E, Harrison, J, Lawrence, E, El-Dalil, P, Parekh, D, Osman, H, Gordon, TP, Nazy, I, Warkentin, TE & Lester, WA 2025, 'Anti-PF4 mediated thrombocytopenia and thrombosis associated with acute cytomegalovirus infection displays both HIT-like and VITT-like characteristics', British Journal of Haematology, vol. 206, no. 6, pp. 1737-1742. https://doi.org/10.1111/bjh.20092

TY - JOUR

T1 - Anti-PF4 mediated thrombocytopenia and thrombosis associated with acute cytomegalovirus infection displays both HIT-like and VITT-like characteristics

AU - Nicolson, Phillip L.R.

AU - Montague, Samantha J.

AU - Buka, Richard J.

AU - Calvert, Anthony

AU - Sheppard, Jo Ann I.

AU - Zhang, Yi

AU - Wang, Jing Jing

AU - Sharman, Jack

AU - Hassan, Eman

AU - Harrison, James

AU - Lawrence, Errin

AU - El-Dalil, Phillip

AU - Parekh, Dhruv

AU - Osman, Husam

AU - Gordon, Tom P.

AU - Nazy, Ishac

AU - Warkentin, Theodore E.

AU - Lester, Will A.

PY - 2025/6

Y1 - 2025/6

N2 - Vaccine-induced immune thrombocytopenia and thrombosis (VITT) is one of several anti-platelet factor 4 (anti-PF4)-associated immune thrombocytopenia and thrombosis (PITT) syndromes. As well as following adenoviral vector vaccines, VITT has recently been described following acute adenovirus infection. We describe a patient with PITT following acute cytomegalovirus infection. The antibody clonotype and PF4 epitopes were distinct from those identified in VITT, and they were detectable as a paraprotein. PITT should be considered in all patients with thrombocytopenia and thrombosis, even without preceding vaccination or heparin, but who otherwise meet the VITT criteria defined by the British Society of Haematology Expert Panel.

AB - Vaccine-induced immune thrombocytopenia and thrombosis (VITT) is one of several anti-platelet factor 4 (anti-PF4)-associated immune thrombocytopenia and thrombosis (PITT) syndromes. As well as following adenoviral vector vaccines, VITT has recently been described following acute adenovirus infection. We describe a patient with PITT following acute cytomegalovirus infection. The antibody clonotype and PF4 epitopes were distinct from those identified in VITT, and they were detectable as a paraprotein. PITT should be considered in all patients with thrombocytopenia and thrombosis, even without preceding vaccination or heparin, but who otherwise meet the VITT criteria defined by the British Society of Haematology Expert Panel.

KW - cytomegalovirus

KW - FCY receptor

KW - heparin-induced TP

KW - monoclonal antibodies

KW - platelet activation

KW - platelet factor 4

KW - thrombocytopenia

KW - thrombosis

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DO - 10.1111/bjh.20092

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VL - 206

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JO - British Journal of Haematology

JF - British Journal of Haematology

IS - 6

ER -

Anti-PF4 mediated thrombocytopenia and thrombosis associated with acute cytomegalovirus infection displays both HIT-like and VITT-like characteristics

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