SARS-CoV-2 infection associated with aplastic anemia and pure red cell aplasia

Abstract

Aplastic anemia (AA) is a rare life-threatening disorder characterized by pancytopenia and a hypocellular bone marrow. 1 Pure red cell aplasia (PRCA) is a more limited marrow failure syndrome, with primary reduction in red blood cell production and virtual absence of marrow erythroid precursors. Although the etiology of immune-mediated marrow failure is complex, preceding viral infections have been associated with AA and PRCA, including parvovirus B19, cytomegalovirus, and Epstein-Barr virus. We present 6 cases of new-onset marrow failure (AA or PRCA) presumably associated with preceding severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.The records of patients treated for AA or PRCA at the University of Texas Southwestern, Parkland Hospital, the National Institutes of Health, and Mount Sinai were reviewed for SARS-CoV-2 infection. Six patients without prior hematologic diseases or SARS-CoV-2 vaccination were identified who had SARS-CoV-2 infection presumably before the diagnosis of AA or PRCA. This study was approved by the University of Texas Southwestern Medical Center Institutional Review Board (STU-2020-0832) and was performed according to the Declaration of Helsinki.

Exacerbation of autoimmune hemolytic anemia associated with pure red cell aplasia after COVID-19: A case report

“…Our case was associated with simultaneous occurrence of AIHA and PRCA after COVID-19. As per our search, simultaneous occurrence of AIHA and PRCA [ 14 , 15 ], or occurrence of PRCA [ 12 , 13 ] after COVID-19 have rarely been reported. Those reported patients including our case are summarized in Table 2 .…”

“…Previous cases [ 5 , 6 , [8] , [9] , [10] , [13] , [14] , [15] ] were mostly associated with severe COVID-19 infections, suggesting that the mechanisms of AIHA or PRCA may be related to the high inflammatory response evoked by COVID-19. However, the AIHA case reported by Liput et al [ 11 ] was induced by asymptomatic COVID-19 infection.…”

“…Currently, reports of AIHA occurrence after COVID-19 are being accumulated [ [5] , [6] , [7] , [8] , [9] , [10] , [11] ]. However, reports of PRCA [ 12 , 13 ] or the simultaneous occurrence of AIHA and PRCA [ 14 , 15 ] have rarely been reported. Moreover, the manifestation of COVID-19 in our case was low-grade and only associated with mild fever.…”

Clinical outcomes and immune responses to SARS‐CoV‐2 vaccination in severe aplastic anaemia

“…Acute viral infections are a suspected trigger for AA and emerging case reports have described individuals who developed COVID‐19‐associated acquired AA. 9 , 10 Therefore, evaluation of the risk–benefit profile of COVID‐19 vaccination in this population is warranted.…”

Efficacy of anti‐severe acute respiratory syndrome coronavirus 2 mRNA vaccines in adults with severe acquired aplastic anemia with or without allogeneic hematopoietic stem cell transplantation

“…In a recent study of 23 non‐vaccinated AA patients, including seven with a previous Allo‐HSCT, 29% had to be hospitalized after COVID‐19 infection, one died and 65% showed a decline in blood parameters with worsening of cytopenias and increasing need for transfusions. [ 6 ] Some data exist also on post‐vaccination results after treatment by horse antithymocyte globulin (hATG) and cyclosporin (CsA) [ 8 , 9 ] while a few cases of AA have been possibly related to COVID‐19 infection [ 10 , 11 ] or vaccination [ 12 , 13 , 14 , 15 ]. However, as yet, no specific results are available regarding vaccines for AA patients who received an Allo‐HSCT.…”