Histopathologically TMA-like distribution of multiple organ thromboses following the initial dose of the BNT162b2 mRNA vaccine (Comirnaty, Pfizer/BioNTech): an autopsy case report

Table 1 Review of literature on thrombosis in each thrombotic microangiopathy and relative disease

Pathophysiology	Characteristic thrombi distribution	Chief thrombus vessel	Thrombus components	Other features (if any)	Reference
TTP	Heart, adrenal gland, kidney, pancreas, brain, liver, and spleen	Arteriole/capillary	Platelet	Thrombi were rarely found in the lung, bone marrow, and GI tract	[19,20,21,22]
HUS	Kidney and pancreas	Arteriole/capillary	Fibrin		[19]
TMA with catastrophic APS	Kidney, heart, lung, brain, and spleen	Arteriole/capillary	Platelet/Fibrin		[41,42,43,44]
TMA with SSc	Kidney (intracapillary)	Arteriole/capillary	Fibrin	Characteristics of vascular endothelial injuries and proliferation on small arterioles	[49, 50]
TMA after bone marrow transplant	Kidney and intestine	Arteriole/small arteries	Fibrin	In the large intestine, the right colon was affected	[51,52,53]
Pregnancy associated TMA, HELLP	Kidney, lung, and intestine	Arteriole	Platelet/Fibrin	Multiple blackish-reddish patches and confluent hemorrhagic foci on the liver	[54,55,56]
DIC	Kidney, lung, spleen, and adrenal gland	Arteriole/capillary	Fibrin		[25, 26]
PNH	Hepatic vein	Veins > arteries	Fibrin/platelet	Hemosiderin deposition on the renal tubular epithelium	[27,28,29]
HIT	Lung, GI tract	Arteries/veins	Platelet		[30,31,32,33]
TTS/VITT	CVS, portal, splenic, and SMV	Veins	Platelet/Fibrin		[34,35,36,37,38,39,40]
TMA after mRNA-1273 vaccination	Kidney, liver, and GI tract	Small arteries	Platelet	Lupus anticoagulant was positive	[46]
Our case	Heart, adrenal gland, kidney, liver, pancreas, brain, and pons	Arteriole/capillary	Platelet	Thrombi were not found in the lungs or GI tract

TMA = thrombotic microangiopathy, TTP = thrombotic thrombocytopenic purpura, HUS = haemolytic uraemic syndrome, APS = antiphospholipid syndrome, SSc = systemic sclerosis, HELLP = haemolysis, elevated liver function tests, low platelets syndrome, DIC = disseminated intravascular coagulation, PNH = paroximal nocturnal haemoglobinuria, HIT = heparin-induced thrombocytopenia, TTS = thrombosis with thrombocytopenia syndrome, VITT = vaccine-induced immune thrombotic thrombocytopenia, CVS = cerebral venous sinus, GI = gastrointestinal, SMV = superior mesenteric vein

ISSN: 1477-9560