How to prevent adverse events of blood clots in AstraZeneca vaccination
Can we ask the vaccinator, "Do you pull back the plunger and
then push the vaccine? Do you Aspirate?" When the vaccination
for covid started there were reports of worrisome incidents of
adverse events post immunisation, the serious complaints being
non-specific blood clots. These related to viral vector vaccines of
human and non-human source: AstraZeneca and Janssen. How
did it happen. There are various views. But here is a suggestion
how simply it can be prevented.
NEW DELHI, July 23: Blood clots have been reported as one of the AEFIs (Adverse
Event Following Immunisation) of viral vector vaccines for covid such as Oxford-AstraZeneca
(uses non-human vector), Russian Sputnik and Johnson & Johnson's Janssen in
some countries. The CDC too had earlier warned of a rare risk of blood clots
with low platelets after receiving Janssen. The condition is called Thrombotic
Thrombocytopenic Syndrome (TTS). The clots can form in small blood vessels anywhere
in the body. They block the flow of blood, and thereby oxygen, to various organs
like brain, kidneys and heart and lead to serious medical problems.
Now, how does Thrombotic Thrombocytopenic Syndrome or blood clots occur post
inoculation of viral vector vaccines. There have been debates in the recent
times how does it happen. And different views have emerged.
When vaccine enters blood stream, and not the muscle
The vaccinators sometimes accidentally hit your blood vessels, especially when
the skin is pinched up, and the needle is not going deep enough to enter the
muscles targeted. (There is a network of blood vessels between the skin and
the muscle, in the subcutaneous area.) With the result, some of the vaccine
enters the blood stream, instead of the muscle tissues. The vaccination therefore
will be less effective too, but what is more serious is the response it creates
in the blood, even though the vaccine dose is very little. However, the incident
is very rare: A one-in-a-thousadnd chance! This clotting event is reportedly
occurring in the case of the three adenovirus viral vector vaccines.
Earlier in the month of March German and Norwegian researchers had found that
a rare autoimmune reaction is behind several cases of brain blood clotting following AstraZeneca vaccination.
How does this autoimmune reaction take place. Reactions can occur in the bloodstream
due to adenovirus particles, whether human or non-human. Receptor interaction
between adenovirus particles and platelets has also been reported. The violent
immune response that hits randomly results in a cytokine storm leading to coagulation
problems, inducing thrombocytopenia, in unpredictable parts.
In England, the vaccinators have to indicate in a form whether blood was seen
after the injection!
Pulling the plunger
In the established practice of aspirating the plunger, the needle must be changed
and a new dose used if there is blood drawn to the syringe.
The vaccinators, newly recruited on a large scale and possibly less experienced,
may not be following the time-tested norm of aspirating the plunger. And, practically,
it is not possible to have enough skilled vaccinators to immunise the whole
world in a short period. Secondly, in the current exigency when the production
of the vaccines for the new pandemic is yet to reach a momentum to provide sufficient
quantities, wasting the dose and changing the needle in case the needle hits
blood vessels may not be thought to be prudent.
Moreover, the social purpose of vaccinating everybody overrides the minuscule
episodes of AEFIs. So let us go ahead and take the jab! Do we stop driving because
the rate of road accidents are quite high.
Non-AEFI blood clot
Unlike AEFIs, non-AEFI kind of blood clot episodes are not uncommon, especially
among those who sit or lie in one position for long like in air travel or in
certain office jobs or patients bedridden etc. There are several types of clots:
DVT, PE, Cerebral Thrombosis that can cause haemorrhage, (stroke) etc. In Deep
Vein Thrombosis (DVT), blood clots (thrombus) form in the deep veins in the
body, usually in the legs. It may cause leg pain or swelling and sometimes there
are no symptoms. The clots can travel up. When a blood clot is lodged in an
artery in the lung, blocking blood flow, it is called Pulmonary Embolism (PE).
In PE there can be a stabbing chest pain, cough and breathlessness. In Cerebral
Thrombosis, the impact may be sudden, leading to cerebral infarction in the
thrombosed brain - a rare episode, mostly seen among those in the 30s. Headache,
blurred vision, seizures, paralysis are the symptoms.
There are modern medicines available today to treat blood clots and blood tests
are there to determine if there had been any clots, like D-Dimer protein test
and ultrasound/CT scan.
Treatment for non-AEFI DVT and PE
Doctors may prescribe blood thinners called anti-coagulants in minor cases
and in more serious cases clot busters called thrombolytics are administered.
Compression stockings may also be advised.
Exercises do help.
Prevention
Raise your legs above heart level several times a day
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Can we ask the vaccinator, "Do you pull back the plunger and
then push the vaccine? Do you Aspirate?" When the vaccination
for covid started there were reports of worrisome incidents of
adverse events post immunisation, the serious complaints being
non-specific blood clots. These related to viral vector vaccines of
human and non-human source: AstraZeneca and Janssen. How
did it happen. There are various views. But here is a suggestion
how simply it can be prevented. 
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