Safety warning for ChAdOx1 nCov-19 vaccine in patients with sickle cell disease

Abstract

Vaccines against acute respiratory syndrome Coronavirus 2(SARS-CoV2) are critical weapons to control the spread of the deadly Coronavirus 2019(COVId-19) virus worldwide. Although these vaccines are generally safe, their widespread use has produced reports of rare complications, including vaccine-induced immune thrombotic thrombocytopenia (VIITT), particularly in connection with ChAdOx1 nCov-19. We have identified three cases of sickle cell disease (SCD) experiencing a severe vaso-occlusive crisis (VOC) shortly after the vaccine. Despite being stable for a long time, they had fever with tachycardia, along with a significant rise in WBC, liver enzymes, particularly alkaline phosphate, with a remarkable drop in hemoglobin, and platelets and one of them probably had fatal TTP like syndrome. Given these findings, physicians and patients should exercise caution when taking this type of vaccine and be aware of these safety concerns.

New-onset and relapsed liver diseases following COVID-19 vaccination: a systematic review

“…Raised liver enzymes (RLEs) was the third most-common disease (twenty-six cases) reported following COVID-19 vaccination from our review (twenty-four new onset cases [9-11, 23, 25-28, 32, 33, 36, 38-40, 46, 70, 77, 79, 83, 94, 114, 121] and two relapsed cases [89,93]) (see Table 1). Most common clinical presentations in those cases who presented with RLEs post-COVID-19 vaccination were fever (n = 11) [9,10,25,28,38,70,77,79,83,114,121], rash (n = 8) [25,32,38,39,79,83,89,94], oedema (n = 8) [25,32,40,79,83,89], weakness (n = 6) [26,28,46,77,79,83,89], fatigue (n = 5) [9,[25][26][27]83], shortness of breath (n = 5) [26,77,78,83,89]…”

“…Most common clinical presentations in those cases who presented with RLEs post-COVID-19 vaccination were fever (n = 11) [9,10,25,28,38,70,77,79,83,114,121], rash (n = 8) [25,32,38,39,79,83,89,94], oedema (n = 8) [25,32,40,79,83,89], weakness (n = 6) [26,28,46,77,79,83,89], fatigue (n = 5) [9,[25][26][27]83], shortness of breath (n = 5) [26,77,78,83,89], vomiting (n = 5) [9,11,39,77,89], abdominal pain (n = 5) [39,46,…”

“…The median (IQR) time between the COVID-19 vaccination and time of presentation was 7 (4.5-11.5) days. Eleven, nine, and four of these twenty-five cases were reported following Pfizer-BioNTech (five after the first dose and six after the second dose) [9, 10, 25, 27, 28, 38-40, 79, 83, 93], Oxford Uni-AstraZeneca (eight after the first dose and one after the second dose) [23,32,33,36,46,77,114], and Moderna (four after the first dose) [26,70,89,94] vaccination; respectively. Only two cases presented with RLEs were reported after Johnson & Johnson COVID-19 vaccination [11,121].…”

“…Patients who suffered RLEs post-COVID-19 vaccination were more likely to have high C-reactive protein (n = 14) [10,11,23,25,32,33,36,38,70,89,114,121], thrombocytopenia (n = 13) [10,11,27,33,39,83,89,93,94,114,121], high lactate dehydrogenase (n = 11) [10,11,26,27,33,36,39,46,83,89,93], raised bilirubin (n = 10) [10,11,26,27,38,39,79,83,89,114], low haemoglobin (n = 7) [11,27,33,38,39,…”

Efficacy and Safety of Sinopharm Vaccine for Sars-Cov-2 and Breakthrough Infections in Iranian Patients With Hemoglobinopathies: A Preliminary Report

“…32 Moreover, getting a booster shot may help prevent a breakthrough infection or have symptoms, as recommended by the CDC. 33 Conclusions Although the safety concern of Astra Zeneca was evaluated in three patients with S/B 0 thalassemia, 34 the current research is the first study that has evaluated the safety and efficacy of the COVID-19 vaccine in a large population of patients with hemoglobinopathies. No safety concerns were identified in our patients who received two doses of the Sinopharm vaccine.…”