A Case of Autoimmune Hemolytic Anemia Following COVID-19 Messenger Ribonucleic Acid Vaccination

Brito, Sara; Ferreira, Nuno; Mateus, S. R. M; Bernardo, Matteo Di; Pinto, Beatriz; Lourenço, Ana Karla Rodrigues; Grenho, Fátima

doi:10.7759/cureus.15035

Cited by 23 publications

(28 citation statements)

References 4 publications

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“…Most studies demonstrated the occurrence of thrombocytopenia or progression of ITP [ 3 – 5 ]. Two recent studies have presented cases of AIHA two days and three weeks after receiving the second dose of the mRNA COVID-19 vaccine [ 12 , 13 ]. In addition, hemolytic attack was observed in 6 patients with PNH after vaccination [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

New-onset Evans syndrome associated with systemic lupus erythematosus after BNT162b2 mRNA COVID-19 vaccination

et al. 2021

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Evans syndrome presents as concurrent autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP). Systemic lupus erythematosus (SLE) is the most frequent autoimmune disorder associated with Evans syndrome. We herein report a case of new-onset Evans syndrome associated with SLE after BNT162b2 mRNA coronavirus disease 2019 (COVID-19) vaccination in a 53-year-old woman. Blood examination at diagnosis showed hemolytic anemia with a positive Coombs test and thrombocytopenia. Hypocomplementemia and the presence of lupus anticoagulant indicated a strong association with SLE. Prednisolone administration rapidly restored hemoglobin level and platelet count. This case suggests that mRNA COVID-19 vaccination may cause an autoimmune disorder. Physicians should be aware of this adverse reaction by mRNA COVID-19 vaccination and should consider the benefits and risks of vaccination for each recipient.

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Section: Discussionmentioning

confidence: 99%

New-onset Evans syndrome associated with systemic lupus erythematosus after BNT162b2 mRNA COVID-19 vaccination

et al. 2021

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“…As shown in Table 4, only 4 cases of CAD or mixed form of AIHA (i.e., direct anti-globulin test positive for IgG plus C at high titer) developing (N=2) or reactivating (N=2) after SARS-CoV-2 vaccination have been reported (23,28,51,52). Al Aoun et al reported a 45-year-old female patient developing severe CAD 3 days after the first dose of Pfizer vaccine.…”

Section: Literature Reviewmentioning

confidence: 99%

Complement Mediated Hemolytic Anemias in the COVID-19 Era: Case Series and Review of the Literature

et al. 2021

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The complex pathophysiologic interplay between SARS-CoV-2 infection and complement activation is the subject of active investigation. It is clinically mirrored by the occurrence of exacerbations of complement mediated diseases during COVID-19 infection. These include complement-mediated hemolytic anemias such as paroxysmal nocturnal hemoglobinuria (PNH), autoimmune hemolytic anemia (AIHA), particularly cold agglutinin disease (CAD), and hemolytic uremic syndrome (HUS). All these conditions may benefit from complement inhibitors that are also under study for COVID-19 disease. Hemolytic exacerbations in these conditions may occur upon several triggers including infections and vaccines and may require transfusions, treatment with complement inhibitors and/or immunosuppressors (i.e., steroids and rituximab for AIHA), and result in thrombotic complications. In this manuscript we describe four patients (2 with PNH and 2 with CAD) who experienced hemolytic flares after either COVID-19 infection or SARS-Cov2 vaccine and provide a review of the most recent literature. We report that most episodes occurred within the first 10 days after COVID-19 infection/vaccination and suggest laboratory monitoring (Hb and LDH levels) in that period. Moreover, in our experience and in the literature, hemolytic exacerbations occurring during COVID-19 infection were more severe, required greater therapeutic intervention, and carried more complications including fatalities, as compared to those developing after SARS-CoV-2 vaccine, suggesting the importance of vaccinating this patient population. Patient education remains pivotal to promptly recognize signs/symptoms of hemolytic flares and to refer to medical attention. Treatment choice should be based on the severity of the hemolytic exacerbation as well as of that of COVID-19 infection. Therapies include transfusions, complement inhibitor initiation/additional dose in the case of PNH, steroids/rituximab in patients with CAD and warm type AIHA, plasma exchange, hemodialysis and complement inhibitor in the case of atypical HUS. Finally, anti-thrombotic prophylaxis should be always considered in these settings, provided safe platelet counts.

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“…To the best of our knowledge, this is the third report showing a delayed onset of AIHA (twenty-fifth day from symptom onset). Moreover, in most relevant cases reported so far, the patients suffered from malignant or lymphoproliferative disorders such as chronic lymphocytic leukemia, monoclonal gammopathy of undetermined significance, and one patient had a prior history of congenital thrombocytopenia [2,7]. In contrast, our patient did not have any predisposing conditions and probable risk factors.…”

Section: Discussionmentioning

confidence: 67%

First Case of Autoimmune Hemolytic Anemia Associated With COVID-19 Infection in Sri Lanka: A Case Report

Arunpriyandan¹,

Kumanan²,

Pakkiyaretnam³

2021

Cureus

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A Case of Autoimmune Hemolytic Anemia Following COVID-19 Messenger Ribonucleic Acid Vaccination

Abstract: Brito et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cited by 23 publications

References 4 publications

New-onset Evans syndrome associated with systemic lupus erythematosus after BNT162b2 mRNA COVID-19 vaccination

New-onset Evans syndrome associated with systemic lupus erythematosus after BNT162b2 mRNA COVID-19 vaccination

Complement Mediated Hemolytic Anemias in the COVID-19 Era: Case Series and Review of the Literature

First Case of Autoimmune Hemolytic Anemia Associated With COVID-19 Infection in Sri Lanka: A Case Report

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