Hematologist in case of TTS

[edwardandtubs]

Current figures from the UK and Australia suggest a one in 50,000 chance of getting TTS if you're under 50 and get the AstraZeneca vaccine. I don't want to get involved in a big discussion about relative risks or anything. I know the chances are very small. However, if you do get TTS you need to urgently see a hematologist. The fact that there's only been one reported case of TTS in Thailand suggests that's not happening here. 

 

Anyway, I'm definitely going to get the AstraZeneca vaccine if it's offered to me but in the extremely unlikely event that I do start suffering the symptoms of TTS, where would be a good place to go to get it diagnosed and treated? I suspect your average government hospital wouldn't have a clue what to do, hence the massive under reporting of this condition in Thailand. Would a hospital like Bumrungrad be any better?

[Sheryl]

Initial diagnosis and management does not require a hematologist.

 

If you develop symptoms go at once to the Emergency room of a major hospital (in the case of government hospitals that would be a regional level or higher facility)

[edwardandtubs]

1 minute ago, Sheryl said:

Initial diagnosis and management does not require a hematologist.

 

If you develop symptoms go at once to the Emergency room of a major hospital (in the case of government hospitals that would be a regional level or higher facility)

My suspicion is though that they wouldn't be able to diagnose it. How else can we explain only 1 TTS case from several million doses? 

[Sheryl]

34 minutes ago, edwardandtubs said:

My suspicion is though that they wouldn't be able to diagnose it. How else can we explain only 1 TTS case from several million doses? 

 

Comparatively small number of doses of AZ given, and most of these to people over 60.

 

TTS mainly occurs in people under 30 and incidence is somewhere between 1 in 100,000 - 1 in 300,000.  Unlikely more than that number of under 30's have so far received AZ.

 

And I think that 1 case is of death, not all cases of TTS - I have nto seen that number announced anywhere. But given the age group that has so far had access to AZ, number would be very, very small.

[edwardandtubs]

9 minutes ago, Sheryl said:

 

Comparatively small number of doses of AZ given, and most of these to people over 60.

 

TTS mainly occurs in people under 30 and incidence is somewhere between 1 in 100,000 - 1 in 300,000.  Unlikely more than that number of under 30's have so far received AZ.

Government statistics from the UK and Australia show that it affects all age groups although the younger you are the more at risk you are. It isn't true to say that it mainly occurs in those under 30 though. It's about 1 in 50,000 for those under 50 and 1 in 100,000 for those over 50 according to UK government websites. Australia has the risk as even higher:

https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/learn-about-covid-19-vaccines/about-the-astrazeneca-covid-19-vaccine#thrombosis-with-thrombocytopenia-syndrome-tts

 

So with a risk of one in 100,000 and over 6 million doses given, you would expect about 60 cases of TTS by now. Even if the risk was only one in 300,000 you would expect 20 cases. It's just not credible that there's only been one case and no deaths. For me the only explanation is that people with TTS are presenting to hospitals but not being properly diagnosed and treated.

 

Edited August 1, 2021 by edwardandtubs

[Sheryl]

10 minutes ago, edwardandtubs said:

Government statistics from the UK and Australia show that it affects all age groups although the younger you are the more at risk you are. It isn't true to say that it mainly occurs in those under 30 though. It's about 1 in 50,000 for those under 50 and 1 in 100,000 for those over 50 according to UK government websites. Australia has the risk as even higher:

https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/learn-about-covid-19-vaccines/about-the-astrazeneca-covid-19-vaccine#thrombosis-with-thrombocytopenia-syndrome-tts

 

So with a risk of one in 100,000 and over 6 million doses given, you would expect about 60 cases of TTS by now. Even if the risk was only one in 300,000 you would expect 20 cases. It's just not credible that there's only been one case and no deaths. For me the only explanation is that people with TTS are presenting to hospitals but not being properly diagnosed and treated.

 

From your link (incidence per 100,000 doses AZ)

<50 years	3.1
50-59 years	2.7
60-69 years	1.4
70-79 years	1.8
80+ years	1.9

 

Also, you should nto confusethe incidence of a condition which occurs in unvaccinated people as well, with vaccine-related increase in incidence.

[edwardandtubs]

Just now, Sheryl said:

 

You are confusing the incidence of a condition which occurs in unvaccinated people as well, with vaccine-related increase in incidence.

No I'm not confusing that. The background rate of TTS is very low (about two in a million per year) so statistically there should certainly have been more than one case of TTS associated with the AstraZeneca vaccine in Thailand by now.

[edwardandtubs]

11 minutes ago, Sheryl said:

From your link (incidence per 100,000 doses AZ)

<50 years	3.1
50-59 years	2.7
60-69 years	1.4
70-79 years	1.8
80+ years	1.9

 

Also, you should nto confusethe incidence of a condition which occurs in unvaccinated people as well, with vaccine-related increase in incidence.

The background rate is 2 in a million per year. The average rate across all age groups after a first dose of AstraZeneca is 8.1 per million.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01693-7/fulltext

 

So there should certainly have been several TTS cases in Thailand by now following millions of first doses of AstraZeneca.

Edited August 1, 2021 by edwardandtubs

[Sheryl]

I don't know where you get your statistics from. The best estimate of rates of TTS in unvaccinated persons is between 3.5 - 7.5 per million persons per year. That is all ages, and in unvaccinated persons it is higher at older ages.   There is no evidence of increased risk of TTS after AZ vaccine in older people.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01693-7/fulltext#sec1

(download the supplemntary appendix)

 

 

 

[Sheryl]

5 minutes ago, edwardandtubs said:

The background rate is 2 in a million per year. The average rate across all age groups after a first dose of AstraZeneca is 8.1 per million.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01693-7/fulltext

 

So there should certainly have been several TTS cases in Thailand by now following millions of first doses of AstraZeneca.

As above, the background rate is higher than that, see the appendix to that article.

 

There would be a small number of  TTS cases per year in Thailand even in the absence of vaccination. But there is no reporting of this diagnosis in Thailand just as there is no reporting of most rare conditions.

 

There is reporting of suspected adverse reactions to the vaccine but I have never seen this data  published. The only things that have appeared in the media are related to investigated deaths and are so garbled as to make interpretation difficult.

[edwardandtubs]

1 minute ago, Sheryl said:

I don't know where you get your statistics from. The best estimate of rates of TTS in unvaccinated persons is between 3.5 - 7.5 per million persons per year. That is all ages, and in unvaccinated persons it is higher at older ages.   There is no evidence of increased risk of TTS after AZ vaccine in older people.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01693-7/fulltext#sec1

(download the supplemntary appendix)

 

 

 

Ok it seems the background rate they're talking about is not annual but they talk about just over two in a million TTS cases after the second dose which they say is the same as the background rate. But in that very same article they report 8.1 per million after the first dose of AstraZeneca. This is in accordance with what the EU and UK medical authorities are reporting.

 

Now if they had only been vaccinating people in their 70s this might well explain the low rate of TTS in Thailand but this isn't the case. Younger people with pre-existing conditions have also been vaccinated as have medical staff and teachers among others. Certainly hundreds of thousands of people under 60 have already been vaccinated but only a single case of TTS. It doesn't add up.

[edwardandtubs]

5 minutes ago, Sheryl said:

 

 

There is reporting of suspected adverse reactions to the vaccine but I have never seen this data  published. The only things that have appeared in the media are related to investigated deaths and are so garbled as to make interpretation difficult.

There was an article here on this forum quite recently that there was only one TTS case and she had quickly recovered. There were reports of deaths but these were supposedly not related to the vaccine. My suspicion is that some of those deaths were in fact undiagnosed TTS cases.

Edited August 1, 2021 by edwardandtubs

[Liebemein]

Have you checked blood test yet? Would be urgent blood tests for CBC, APTT, PT, fibrinogen and D-dimer. Do you have baseline? Big private hospital can check for this test such as Bamrungrad and medical schools. However for the diagnosis would be specific doctor. Just give the history of AZ suspected.

[Sheryl]

19 minutes ago, Liebemein said:

Have you checked blood test yet? Would be urgent blood tests for CBC, APTT, PT, fibrinogen and D-dimer. Do you have baseline? Big private hospital can check for this test such as Bamrungrad and medical schools. However for the diagnosis would be specific doctor. Just give the history of AZ suspected.

He does not suspect he has TTS now. He is asking as a precaution.

[edwardandtubs]

10 minutes ago, Liebemein said:

Have you checked blood test yet? Would be urgent blood tests for CBC, APTT, PT, fibrinogen and D-dimer. Do you have baseline? Big private hospital can check for this test such as Bamrungrad and medical schools. However for the diagnosis would be specific doctor. Just give the history of AZ suspected.

You would definitely think a hospital like Bumrungrad would be able to diagnose and treat. But with hospitals overrun by covid patients who themselves are much more likely to suffer from blood clots, I do worry that they're just telling people who have had the AstraZeneca vaccine to go home and take a paracetamol and consequently missing cases.

[Sheryl]

25 minutes ago, Liebemein said:

Have you checked blood test yet? Would be urgent blood tests for CBC, APTT, PT, fibrinogen and D-dimer. Do you have baseline? Big private hospital can check for this test such as Bamrungrad and medical schools. However for the diagnosis would be specific doctor. Just give the history of AZ suspected.

He does not suspect he has TTS now. He is asking as a precaution.

[Sheryl]

17 minutes ago, edwardandtubs said:

You would definitely think a hospital like Bumrungrad would be able to diagnose and treat. But with hospitals overrun by covid patients who themselves are much more likely to suffer from blood clots, I do worry that they're just telling people who have had the AstraZeneca vaccine to go home and take a paracetamol and consequently missing cases.

If you actually have symptoms suggestive of a blood clot I do not think this will happen. But do present through ER, not by making an appointment with a hematologist. 

[Liebemein]

5 minutes ago, Sheryl said:

He does not suspect he has TTS now. He is asking as a precaution.

Laboratory tests above especially D-dimer and platelet count would help before the jab and check if after vaccination. There are some hospitals are doing research about this, if you can apply in it.

[Captor]

I would like to know what the symptoms are? My wife will go soon in mid August and get the first jab. She is Thai and 46 years old. IF they give AZ then I would like to know what symptoms to look after?

[edwardandtubs]

1 hour ago, Captor said:

I would like to know what the symptoms are? My wife will go soon in mid August and get the first jab. She is Thai and 46 years old. IF they give AZ then I would like to know what symptoms to look after?

What are the symptoms of thrombosis with thrombocytopenia syndrome?

You should seek medical attention immediately if, following vaccination, you have any of these symptoms:

 

a severe or persistent headache that:

starts at least 4 days after vaccination

doesn’t improve with simple pain-relief medicines such as paracetamol

may be worse when lying down

may be accompanied by nausea and vomiting

blurred vision

difficulty speaking

difficulty breathing

chest pain

drowsiness

seizures

swelling in the leg

persistent abdominal (stomach) pain associated with feeling unwell

tiny blood spots under the skin, away from the site of injection

Common and expected side effects of COVID-19 vaccines include fever, sore muscles, tiredness and headache. These usually start within 24 hours of vaccination and last for 1 to 2 days. These side effects shouldn’t worry you unless they’re severe or persistent.

https://www.healthdirect.gov.au/thrombosis-with-thrombocytopenia-syndrome-tts#symptoms

[Captor]

2 hours ago, edwardandtubs said:

What are the symptoms of thrombosis with thrombocytopenia syndrome?

You should seek medical attention immediately if, following vaccination, you have any of these symptoms:

 

a severe or persistent headache that:

starts at least 4 days after vaccination

doesn’t improve with simple pain-relief medicines such as paracetamol

may be worse when lying down

may be accompanied by nausea and vomiting

blurred vision

difficulty speaking

difficulty breathing

chest pain

drowsiness

seizures

swelling in the leg

persistent abdominal (stomach) pain associated with feeling unwell

tiny blood spots under the skin, away from the site of injection

Common and expected side effects of COVID-19 vaccines include fever, sore muscles, tiredness and headache. These usually start within 24 hours of vaccination and last for 1 to 2 days. These side effects shouldn’t worry you unless they’re severe or persistent.

https://www.healthdirect.gov.au/thrombosis-with-thrombocytopenia-syndrome-tts#symptoms

Very nice! Thank you very much!

[Liebemein]

On 8/2/2021 at 1:45 AM, edwardandtubs said:

What are the symptoms of thrombosis with thrombocytopenia syndrome?

You should seek medical attention immediately if, following vaccination, you have any of these symptoms:

 

a severe or persistent headache that:

starts at least 4 days after vaccination

doesn’t improve with simple pain-relief medicines such as paracetamol

may be worse when lying down

may be accompanied by nausea and vomiting

blurred vision

difficulty speaking

difficulty breathing

chest pain

drowsiness

seizures

swelling in the leg

persistent abdominal (stomach) pain associated with feeling unwell

tiny blood spots under the skin, away from the site of injection

Common and expected side effects of COVID-19 vaccines include fever, sore muscles, tiredness and headache. These usually start within 24 hours of vaccination and last for 1 to 2 days. These side effects shouldn’t worry you unless they’re severe or persistent.

https://www.healthdirect.gov.au/thrombosis-with-thrombocytopenia-syndrome-tts#symptoms

✔ This Thai news which I could not find in English was just showed up exactly the same symptoms from your lists happened to his wife who was 28 years without underlying after AZ. He and his lawyer will find out...another victim

[Captor]

1 hour ago, Liebemein said:

✔ This Thai news which I could not find in English was just showed up exactly the same symptoms from your lists happened to his wife who was 28 years without underlying after AZ. He and his lawyer will find out...another victim

Can you post the Thai link?

[drenddy]

In case of TTS, time is crucial and, of course, competent doctors.Some of the cases, I read about from Italy, people went to hospital and, after medical check up and MRI, they got sent home, only to return few days later, when nothing could be done.

Case fatality rate is high.

[edwardandtubs]

7 hours ago, drenddy said:

In case of TTS, time is crucial and, of course, competent doctors.Some of the cases, I read about from Italy, people went to hospital and, after medical check up and MRI, they got sent home, only to return few days later, when nothing could be done.

Case fatality rate is high.

This is exactly what I think is happening right now in Thailand. There are in fact blood tests that can diagnose TTS but I haven't heard any reports of these being available in Thailand. Because of early diagnosis the case fatality rate has gone from around 25% or higher to less than 10%.

https://www.smh.com.au/national/we-can-treat-it-mortality-rate-of-rare-condition-linked-to-astrazeneca-shot-plunges-20210607-p57yod.html

Basically as long as you get it diagnosed early, you'll live but if not you'll probably die.

 

Edited August 5, 2021 by edwardandtubs

[Liebemein]

12 hours ago, Captor said:

Can you post the Thai link?

Actually I had seen it on another social channel. It has gone when I searched again, sometimes many things are disappeared, smell fishy.

https://www.thairath.co.th/news/local/central/2157007

[edwardandtubs]

1 hour ago, Liebemein said:

Actually I had seen it on another social channel. It has gone when I searched again, sometimes many things are disappeared, smell fishy.

https://www.thairath.co.th/news/local/central/2157007

Good link. This is exactly the kind of thing I fear is happening. If the story is true it seems the patient was given painkillers and four critical days were lost, sadly resulting in death. From Google translate:

 

"Later on July 20, he had a severe left-sided headache. In addition, the left eye is blurry, has no strength, and can't speak. So he took him to check at Phranangklao Hospital. which the doctor performed a brain scan found to have thrombosis in the veins in the brain The doctor has given painkillers to relieve pain. But my boyfriend's symptoms didn't improve.

 

 

Then on July 24, the doctor gave the drug to dissolve blood clots. but the symptoms did not improve At that time, her boyfriend was in a coma."

[Captor]

On 8/1/2021 at 6:35 PM, Sheryl said:

If you actually have symptoms suggestive of a blood clot I do not think this will happen. But do present through ER, not by making an appointment with a hematologist. 

Dear Sherry,

You seem to know a lot about Thai health care. Do you think the Ratchaphiphat Hospital in Bang Khae would be OK for rthis type of side effect?

At the ICU there (if there is that).

We have never been there only seen it in far distance. It looks not so big.

[Captor]

4 hours ago, Liebemein said:

Actually I had seen it on another social channel. It has gone when I searched again, sometimes many things are disappeared, smell fishy.

https://www.thairath.co.th/news/local/central/2157007

Thanks for the link!

[Liebemein]

45 minutes ago, Captor said:

Dear Sherry,

You seem to know a lot about Thai health care. Do you think the Ratchaphiphat Hospital in Bang Khae would be OK for rthis type of side effect?

At the ICU there (if there is that).

We have never been there only seen it in far distance. It looks not so big.

It's 400-bed hospital. Not sure if it's possible for check all labs especially D-dimer. However if it's emergency, they would do best and can refer later if they need specific treatments and investigation.