A Case of Autoimmune Hemolytic Anemia after the First Dose of COVID-19 mRNA-1273 Vaccine with Undetected Pernicious Anemia

Abstract

By this time, multiple vaccines have been approved to limit the spread of SARS-CoV-2 worldwide. These include new-generation vaccines that contain mRNA of the target organism. Some common side effects were identified and reported during phase 3 clinical trials of vaccination, but more rare adverse events were reported in the literature. One such concern is autoimmune conditions that SARS-CoV-2 viral antigens could have possibly incited. We are presenting here a case of a young female with no known autoimmune diseases, diagnosed with autoimmune hemolytic anemia about a week after receiving her first dose of the COVID-19 mRNA vaccine. We discuss the possible culprit for precipitation of autoimmune hemolytic anemia after the SARS-CoV-2 mRNA vaccine, which encodes virus spike protein. This case highlights the importance of being vigilant for identifying rare adverse events that could appear during mass vaccination.

Vitamin B12 and D deficiency as cofactors of COVID-19 vaccine-induced chronic neurological adverse reactions: Two cases and a hypothesis

“…We are aware of one case study of post-COVID-19 vaccination transverse myelitis with comorbid vitamin B12 deficiency (131 pg/mL) (Gao et al, 2021). Another case, presenting similarly to HAC described above, had vitamin B12 deficiency (< 50 pg/mL), and positive intrinsic factor; lactate dehydrogenase was elevated (4332 U/L) and schistocytes were present suggestive of vitamin B12 deficiency-mediated haemolysis (Jaydev et al, 2022). Thus the diagnosis was vaccine-induced autoimmune haemolytic anaemia, in line with two other case studies we are aware of (Brito et al, 2021;Pérez-Lamas et al, 2021).…”

COVID-19 Vaccines and Autoimmune Hematologic Disorders

“…In three of these cases, symptoms started at a median of five days after administration of the first dose (reviewed in [103]). Three new cases of patients who developed symptoms after receiving the first dose of mRNA-1273, the second dose of mRNA-1273, and the third dose of BNT162b2, respectively, have been reported recently [106][107][108]. The mechanism underlying the association is not understood, although the molecular mimicry between ankyrin-1, a red cell membrane protein, and SARS-CoV-2 spike protein might play a role [109].…”

“…Key concepts AIHA secondary to COVID-19 vaccination was managed with immunosuppressive agents, especially corticosteroids and occasionally rituximab [103,106,107]. A young woman whose case was particularly severe was transfused with 13 units of packed RBCs, and administered corticosteroids, rituximab, mycophenolate mofetil, and immune globulin [108].…”

Current Evidence in SARS-CoV-2 mRNA Vaccines and Post-Vaccination Adverse Reports: Knowns and Unknowns

“…IgG-mediated Autoimmune Haemolytic Anemia (AHA) was reported after mRNA-1273 vaccination in a case with undetected pernicious anemia and, additionally, another woman with a history of postoperative chemotherapy for lung adenocarcinoma and a history of helicobacter pylori eradication for Idiopathic Thrombocytopenic Purpura (ITP) was reported with AHA 2 weeks after BNT162b2 vaccination [ 59 , 60 ]. In addition, there exists another report for severe Aplastic Anemia (AA) following BNT162b2 vaccination, but it is not clear whether antibodies derived from the SARS-CoV-2 vaccine directly contributed to AA because the anti-SARS-CoV-2 antibodies remained after the patient’s pancytopenia had been ameliorated by the allogeneic HSCT [ 61 ].…”