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Annals of Hepatology
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Vol. 24.
(September - October 2021)
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Vol. 24.
(September - October 2021)
Letter to the editor
Open Access
COVID-19 vaccine, immune thrombotic thrombocytopenia, jaundice, hyperviscosity: concern on cases with underlying liver problem
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Pathum Sookaromdee1,
Corresponding author
pathumsook@gmail.com

Correspondence: Pathum Sookaromdee, Private Academic Consultant, Bangkok Thailand
, Viroj Wiwanitkit2
1 Private Academic Consultant, Bangkok Thailand
2 Honorary professor, Dr DY Patil University, Pune, India
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We would like to share ideas on the report "COVID-19 vaccine-induced immune thrombotic thrombocytopenia: An emerging cause of splanchnic vein thrombosis [1]." Aguilar et al. concluded that "We will definitively continue to be updated and "tuned-up" while further research in critical areas like etiopathogenesis and emerging therapies for VITT unfolds in this new fascinating but poorly understood arena of clinical thrombosis......[1]." The adverse effect of COVID-19 vaccine is the present focus at present. The thrombohemostatic disturbance might occur. As noted in the editorial, there are many possible pathomechanisms [1]. We would like to add another possible underlying cause of thrombohemostatic disorder, the vaccine-induced hyperviscosity [2]. The rapid increase of immunity after vaccination might occur, and high blood viscosity can alter the normal thromohemostasis process [3]. The problem might arise in anyone receiving the vaccination. For the patient with underlying liver disease, a more risk might be expected.

Of several underlying pathophysiology, many patients with underlying liver disease usually have a high blood bilirubin level. Since hyperbilirubinemia is associated with increased blood viscosity, a patient with underlying liver disease and jaundice, such as cholangiocarcinoma or chronic active hepatitis, might have an increased chance of post COVID-19 vaccination hyperviscosity and thrombohemostatic disorder. Closed monitoring of the possible adverse effect of COVID-19 among a person with underlying jaundice should be required.

References
[1]
MP Aguilar, AL Langner, A Panduro, M Uribe.
COVID-19 vaccine-induced immune thrombotic thrombocytopenia: An emerging cause of splanchnic vein thrombosis.
Ann Hepatol, 23C (2021),
[2]
B Joob, V Wiwanitkit.
Expected Viscosity After COVID-19 Vaccination, Hyperviscosity and Previous COVID-19.
Clin Appl Thromb Hemost, 27 (2021 Jan-Dec),
[3]
EU Nwose, RS Richards, P Bwititi, E Butkowski.
Serum bilirubin and lipoprotein-a: how are these associated with whole blood viscosity?.
Copyright © 2021. Fundación Clínica Médica Sur, A.C.
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