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Diagnosis of HLH (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6297301/): Meeting 5 out of the following 8 criteria:

* fever

* splenomegaly (enlargement of the spleen)

* cytopenias in peripheral blood:

-*- haemoglobin <90 g/L

-*- platelets <100×109/L

-*- neutrophils <1×109/L

* haemophagocytosis in bone marrow, lymph nodes or spleen

* low or absent natural killer cell activity

* ferritin >500 ng/mL

* raised soluble CD25 (IL-2 receptor)

* fasting hypertriglyceridaemia (>3 mmol/L) or hypofibrinogenaemia

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The COVID-19 vaccines seem to be able to cause hyperactivations of different systems:

- hyperactivation of macrophages (and T-cells) that engulf normal haematopoietic cells in the bone marrow, liver and spleen -> HLH

- hyperactivation of mast cells -> mast cell activation syndrome

- hyperactivation of plateles (as for example an effect of endotheliitis) -> amyloid fibrin microclots -> thrombosis

- hyperactivation of T follicular helper (Tfh) cells -> increased levels of non-specific antibodies and autoimmune antibodies (see https://pubmed.ncbi.nlm.nih.gov/29739835/)

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