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

Sridhara, Srilekha; Nair, Resmi; Stanek, Michael

doi:10.14740/jh954

Cited by 11 publications

(10 citation statements)

References 19 publications

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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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“…Altered hematopoiesis might have contributed to neutropenia. Severe aplastic anemia (affecting the hematopoietic stem cells and characterized by neutropenia and thrombocytopenia)-, cytopenia-and thrombocytopenia cases have all been reported with this platform in humans [43][44][45][46][47][48][49]. One small human study (56 volunteers) that monitored the immunological changes induced by this vaccine up to 21 days after the second shot reported a significant fluctuation in white blood cell numbers after the second injection of mRNA-LNP [11].…”

Section: Plos Pathogensmentioning

confidence: 99%

Pre-exposure to mRNA-LNP inhibits adaptive immune responses and alters innate immune fitness in an inheritable fashion

et al. 2022

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Hundreds of millions of SARS-CoV-2 mRNA-LNP vaccine doses have already been administered to humans. However, we lack a comprehensive understanding of the immune effects of this platform. The mRNA-LNP-based SARS-CoV-2 vaccine is highly inflammatory, and its synthetic ionizable lipid component responsible for the induction of inflammation has a long in vivo half-life. Since chronic inflammation can lead to immune exhaustion and non-responsiveness, we sought to determine the effects of pre-exposure to the mRNA-LNP on adaptive immune responses and innate immune fitness. We found that pre-exposure to mRNA-LNPs or LNP alone led to long-term inhibition of the adaptive immune response, which could be overcome using standard adjuvants. On the other hand, we report that after pre-exposure to mRNA-LNPs, the resistance of mice to heterologous infections with influenza virus increased while resistance to Candida albicans decreased. The diminished resistance to Candida albicans correlated with a general decrease in blood neutrophil percentages. Interestingly, mice pre-exposed to the mRNA-LNP platform can pass down the acquired immune traits to their offspring, providing better protection against influenza. In summary, the mRNA-LNP vaccine platform induces long-term unexpected immunological changes affecting both adaptive immune responses and heterologous protection against infections. Thus, our studies highlight the need for more research to determine this platform’s true impact on human health.

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“…In addition, there has been no method for predicting the development of autoimmune diseases after vaccination. Previous case reports showed that the initial symptoms related to cytopenia or the first complete blood count abnormalities were merged between the day after vaccination and three months later [ 6 – 9 ]. Before vaccination, our patient had no history of infection, change of medications, or other possible causes of cytopenia.…”

Section: Discussionmentioning

confidence: 99%

New onset of hypomegakaryocytic thrombocytopenia with the potential for progression to aplastic anemia after BNT162b2 mRNA COVID-19 vaccination

Kobayashi¹,

Mori²,

Oda

et al. 2023

Int J Hematol

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Vaccination with a coronavirus disease-2019 (COVID-19) vaccine is an effective public health measure for reducing the risk of infection and severe complications from COVID-19. However, serious hematological complications after COVID-19 vaccination have been reported. Here, we report a case of new-onset hypomegakaryocytic thrombocytopenia (HMT) with the potential for progression to aplastic anemia (AA) that developed in a 46-year-old man 4 days after the fourth mRNA COVID-19 vaccination. Platelet count rapidly decreased after vaccination and white blood cell count declined subsequently. Bone marrow examination immediately after disease onset showed severely hypocellular marrow (cellularity of almost 0%) in the absence of fibrosis, findings that were consistent with AA. Since the severity of pancytopenia did not meet the diagnostic criteria for AA, the patient was diagnosed with HMT that could progress to AA. Treatment with eltrombopag and cyclosporine was started immediately after diagnosis and cytopenia improved. Although it is difficult to determine whether the post-vaccination cytopenia was vaccine induced or accidental because the association was chronological, vaccination with an mRNA-based COVID-19 vaccine may be associated with development of HMT/AA. Therefore, physicians should be aware of this rare, but serious adverse event and promptly provide appropriate treatment.

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

Cited by 11 publications

References 19 publications

Acquired aplastic anemia following SARS‐CoV‐2 vaccination

Acquired aplastic anemia following SARS‐CoV‐2 vaccination

Pre-exposure to mRNA-LNP inhibits adaptive immune responses and alters innate immune fitness in an inheritable fashion

New onset of hypomegakaryocytic thrombocytopenia with the potential for progression to aplastic anemia after BNT162b2 mRNA COVID-19 vaccination

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