![]() ![]() ![]() This is significant because approximately 15% of serum IgA molecules are dimers, and thus even larger and less spheroidal. Comirnaty elicits a slightly greater increase in the concentration of IgA than IgG after the second immunization. Immunoglobins are large, non-spheroidal proteins (150-160 kDa). The effect of a protein on plasma viscosity increases with its concentration, molecular weight, and the less spheroidal its shape. Plasma proteins increase blood viscosity by multiple mechanisms: increasing plasma viscosity, increasing erythrocyte aggregation, and decreasing erythrocyte deformability. Albumin concentrations also decrease as part of the acute phase reaction, further increasing blood viscosity. Increased production of acute phase reactants and immunoglobins also increase blood viscosity. Decreased oral fluid intake, sweating, and increased insensible fluid losses due to fever cause hemoconcentration. Inflammation increases blood viscosity by several mechanisms. Myocarditis has also been noted following immunization for malaria, suggesting that its cause is a nonspecific manifestation of inflammation, not a reaction to specific cardiac or coronaviral antigens. The IgG titer following immunization with Comirnaty and Spikevax is inversely related to age. Finally, myocarditis most commonly affects vaccinees less than 30 years of age. Post-immunization myocarditis most commonly occurs following the second immunization, which typically causes higher immunoglobin titers. Hematocrit is the most powerful determinant of blood viscosity. Post-immunization myocarditis disproportionally effects males, who have a higher baseline blood viscosity than females due to their higher hematocrits. The onset of myocarditis within days of immunization is consistent with inflammation and accompanying elevated blood viscosity. Several observations support the hypothesis that post-immunization myocarditis is caused by elevated blood viscosity. We believe this myocarditis is caused by elevated blood viscosity and may be prevented by optimal oral hydration. The disease is usually mild and self-limited. The incidence of myocarditis following immunization for COVID-19 is low, between 0.5 to 2.13 cases per 100,000 vaccinees. The increasing number of reports of myocarditis following immunization for coronavirus 2019 (COVID-19) with Comirnaty (Pfizer-BioNTech), Spikevax (Moderna), and Vaxzevria or Covishield (AstraZeneca) leave little doubt about a cause-and-effect relationship. Myocarditis COVID-19 Immunization Blood Viscosity Hydration Because antibody titers may rise even higher following a second booster, hydration is strongly recommended with the third round of immunization. Post-immunization myocarditis demonstrates that viral invasion is not necessary to cause myocarditis in coronavirus disease 2019. Increased blood viscosity also explains the increased incidence of thrombosis following immunization for coronavirus disease 2019. The most practical prophylaxis for post-immunization hyperviscosity is optimal oral hydration beginning one day before immunization and continuing for one week. This causes an imbalance between myocardialoxygen supply and demand leading to ischemia and myocarditis. Because viscosity is inversely proportional toflow, elevated blood viscosity decreases tissue perfusion. This explains why post-immunization myocarditis occurs most commonly in young males.These males can have a higher baseline blood viscosity, following the second immunization, which causes significantly higher antibody titers than the first immunization, and only with certain vaccine preparations, which differ in the antibody titers they elicit. Inflammation elevates blood viscosity by causing hemoconcentration and the acute phase reaction, which increases the concentration of large proteins such as fibrinogen and immunoglobins and decreases albumin concentrations. Myocarditis and thrombosis following immunization for coronavirus disease 2019 is caused by elevated blood viscosity due to the host inflammatory response. ![]()
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