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

Abstract

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.

Aplastic anemia following the severe acute respiratory syndrome coronavirus‐2 vaccine

“…There have been several reports describing the possible relationship between the severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) vaccine and the development of hematological diseases, such as autoimmune hemolytic anemias, paroxysmal nocturnal hemoglobinuria or immune thrombocytopenic purpura [ 1 , 2 , 3 , 4 , 5 , 6 ]. Although a few reports have mentioned a potential relationship between the SARS‐CoV‐2 vaccine and the development of aplastic anemia (AA), data is still limited [ 7 , 8 , 9 , 10 ].…”

Ph-Positive B-Cell Acute Lymphoblastic Leukemia Occurring after Receipt of Bivalent SARS-CoV-2 mRNA Vaccine Booster: A Case Report

“…Although they have shown effectiveness in reducing COVID-19-related mortality and morbidity [ 2 , 3 , 4 , 5 ], many concerns about the safety of these vaccines were generated regarding their novel genetic technology and materials [ 6 ]. Sporadic hematopoietic adverse events were reported [ 7 , 8 , 9 , 10 ]. The bivalent formulations of BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) COVID-19 vaccines, which can induce remarkably high levels of anti-spike protein antibodies, have demonstrated their significant efficacy against the Omicron variant and acceptable safety in clinical practice [ 11 ].…”

“…Many researchers have provided strong support for the safety and benefits of COVID-19 vaccination [ 2 , 3 , 4 , 5 , 11 , 24 ], but several authors implied immune cell stimulation might be the trigger of the hematologic adverse events after COVID-19 vaccination [ 7 , 8 , 9 , 10 , 25 , 26 ]. An intense vaccination campaign for herd immunity to against SARS-CoV-2 infection is mandatory, however, it is a continuous process for collecting the safety data of these vaccines, especially the current worldwide used booster bivalent formulations of BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) COVID-19 vaccines.…”

An unusual case of acquired aplastic anemia following SARS-CoV-2 vaccination: A case report

“…Aplastic Anemia (AA) is a rare but potentially fatal condition characterized by the destruction of hematopoietic stem cells in the bone marrow, resulting in pancytopenia and an empty bone marrow Aplastic Anemia can be acquired and that can arise from various factors, including autoimmunity, medication-induced toxicity, and exposure to environmental toxins or chemicals [2] . Aplastic Anemia following a COVID-19 vaccine administration is a rare and poorly understood complication of vaccination [3] . While it is unclear how immunizations can cause AA, some theories suggest that they may trigger an autoimmune reaction, leading to the destruction of hematopoietic stem cells.…”

“…While it is unclear how immunizations can cause AA, some theories suggest that they may trigger an autoimmune reaction, leading to the destruction of hematopoietic stem cells. Recently, several cases of Acquired Aplastic Anemia following COVID-19 vaccination have been reported [3] , [4] , [5] , [6] . Although no definitive evidence links the vaccine to the development of AA, these reports have raised concerns and prompted further investigation.…”