Management of patients presenting to the Emergency Department/ Acute Medicine with symptoms

Following a surge in patients attending A+E as a result of anxiety over safety of the AstraZeneca vaccine, the Royal College of Emergency Medicine, the Society for Acute Medicine, and the Royal College of Physicians have produced guidance for doctors seeing such patients.

SPS commentary:

The guidance advises that anyone who presents with symptoms suggestive of covid-19 vaccine induced thrombosis and thrombocytopenia (VITT) should have a full blood count to check platelet level. Symptoms of concern include persistent or severe headaches, seizures, or focal neurology; shortness of breath, persistent chest, or abdominal pain; and swelling, redness, pallor, or cold lower limbs.

The British Society for Haematology says that anyone with suspected VITT should be given intravenous immunoglobulin immediately and anticoagulation with non-heparin based therapies, but that platelet transfusions should be avoided. It stresses that this is an immune condition and there is no evidence that people with a prior history of thrombosis or known risk factors for thrombosis are more at risk. For most people, the risk of recurrent thrombosis from covid-19 infection is greater than the risk of this syndrome.

British Medical Journal