A case of severe aplastic anaemia after SARS‐CoV‐2 vaccination

Cecchi, Nicola; Giannotta, Juri Alessandro; Barcellini, Wilma; Fattizzo, Bruno

doi:10.1111/bjh.17947

Cited by 18 publications

(24 citation statements)

References 18 publications

(30 reference statements)

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“…[13][14][15][16][17][18][19][20] To the best of our knowledge, this is the first comprehensive report of possible COVID-19 vaccinerelated AA relapse reported to date. Our data therefore highlight in conjunction with the observations made by Cecchi et al, 21 Sridhara et al, 22 and Tabata et al 23 (all de novo cases of AA) the potential risk for contracting AA as a potential complication following vaccination against SARS-CoV-2 (vaccine-related adverse event).…”

Section: Introductionsupporting

confidence: 89%

Acquired aplastic anemia following SARS‐CoV‐2 vaccination

Röth¹,

Bertram

Schroeder³

et al. 2022

European J of Haematology

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COVID‐19 is a potential life‐threatening viral disease caused by SARS‐CoV‐2 and was declared a pandemic by the WHO in March 2020. mRNA‐based SARS‐CoV‐2 vaccines are routinely recommended in immune‐compromised patients, including patients with AA, as these patients are at increased risk of contracting COVID‐19 and developing a more severe course of disease. Between March 2021 and November 2021 relapse of AA occurred in four (age [median]: 53 years, range 30–84 years) out of 135 patients currently registered at our department and two de novo cases of AA in temporal context to vaccination against SARS‐CoV‐2, were documented. Median time after first COVID‐19 vaccination and relapse of AA was 77 days. All relapsed patients were vaccinated with the mRNA‐based vaccine Comirnaty®. Relapse in two out of the four patients was refractory to CsA/eltrombopag, favoring IST with hATG/CsA or BMT, respectively. Our observations should prompt clinicians to take vaccine‐induced relapse of AA or de novo AA after SARS‐CoV‐2 vaccination into account. Furthermore, careful clinical monitoring and vigilance for signs or symptoms that may indicate relapse of AA (e.g., bleeding complications) are indicated.

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Section: Introductionsupporting

confidence: 89%

Acquired aplastic anemia following SARS‐CoV‐2 vaccination

Röth¹,

Bertram

Schroeder³

et al. 2022

European J of Haematology

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“…This patient however has persistent pancytopenia and remains transfusion-dependent. The authors hypothesized that vaccine may have induced an immune activation that disclosed a latent autoimmunity [ 18 ]. Tabata et al also reported SAA in a previously healthy 56-year-old man following administration of SARS-CoV-2 Pfizer-BioNTech mRNA vaccination and he was treated with allogeneic hematopoietic stem cell transplantation (HSCT) [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Severe Aplastic Anemia After Receiving SARS-CoV-2 Moderna mRNA Vaccination

Sridhara¹,

Nair²,

Stanek³

2022

J Hematol

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A 60-year-old male patient presented to the emergency department with complaints of easy bruising and worsening epistaxis after receiving severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Moderna mRNA vaccination. He had no personal or family history of hematological conditions. He had bruises in various stages involving the upper and lower extremities. Laboratory data revealed white blood cell count of 1.2 ×10 3 /mm 3 , hemoglobin of 8.0 g/dL, platelet count of 1 ×10 3 /mm 3 , immature platelet fraction of 0.7%, absolute neutrophil count of 0 ×10 3 /µL, lymphocytes of 1.1 ×10 3 /µL, neutrophils of 3% and lymphocytes of 93%. He had normal liver and renal function tests. Bone marrow biopsy confirmed very severe aplastic anemia with severely hypocellular bone marrow. His platelets continued to downtrend despite platelet transfusions and steroids. He was treated with immunosuppressive therapy with cyclosporine, anti-thymocyte globulin, eltrombopag and prednisone. The patient was discharged but was readmitted to the hospital secondary to recurrent neutropenic fever and pneumonia. He had high-grade vancomycin-resistant enterococcal infection and Clostridium difficile infection leading to septic shock and succumbing to cardiac arrest. This case demonstrates the possibility of very severe aplastic anemia following SARS-CoV-2 mRNA vaccination and clinicians need to be aware of this rare but serious side effect.

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“…One case report described how a previously healthy 76-year-old man developed SAA at 1 month after his second dose of the BNT mRNA COVID-19 vaccine. Hematological parameters did not respond to first-line IST (without eltrombopag) and his condition was complicated by serum sickness and infections [ 7 ]. The other case involved a 56-year-old patient who developed VSAA after his second dose of the BNT mRNA COVID-19 vaccine; an allogeneic hematopoietic stem cell transplantation resulted in hematological recovery after 3 weeks [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Case reports of management of aplastic anemia after COVID-19 vaccination: a single institute experience in Taiwan

Chen

Hsieh

et al. 2022

Int J Hematol

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Global vaccination against the coronavirus disease 2019 (COVID-19) is thought to be the most effective way to end or at least contain the COVID-19 pandemic. However, despite the good safety profiles and effectiveness of the available COVID-19 vaccines, rare but serious hematological complications have emerged, including thromboembolic outcomes with thrombocytopenia following the ChAdOx1 nCoV-19 (Oxford-AstraZeneca) and Ad26.COV.2.S (Johnson & Johnson/Janssen) vaccines. Moreover, COVID-19 vaccination may be linked to the development of aplastic anemia (AA). We discuss four cases of AA that arose after COVID-19 vaccination in our hospital and two other such cases identified in our literature review.

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A case of severe aplastic anaemia after SARS‐CoV‐2 vaccination

Cited by 18 publications

References 18 publications

Acquired aplastic anemia following SARS‐CoV‐2 vaccination

Acquired aplastic anemia following SARS‐CoV‐2 vaccination

Severe Aplastic Anemia After Receiving SARS-CoV-2 Moderna mRNA Vaccination

Case reports of management of aplastic anemia after COVID-19 vaccination: a single institute experience in Taiwan

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