TABLE 3.
Characteristics of cases with exacerbated previous autoimmune hemolytic anemia (AIHA) following COVID‐19 vaccination
| Country (case no.) | Anemia type | Gender‐age, years | Vaccine name (vaccine type) | Onset time of symptoms‐primary clinical symptoms | Hematologic test results | Other tests | Medication and outcome | Reference |
|---|---|---|---|---|---|---|---|---|
| Spain (1) a | Cold AIHA | F‐57 | mRNA‐based vaccine |
‐ 2 days after first dose. ‐ Chills, weakness, shortness of breath upon exertion, lumbar pain, jaundice, and mild hemoglobinuria. |
‐ Hb: 8.6 g/dl, high reticulocyte count, spherocytes on the peripheral blood smear. ‐ DAT: Test was positive for C3b and negative for IgG. A cold agglutinin with anti‐I specificity was identified. The cryoagglutinin titer increased after the first dose of the vaccine. |
‐Bilirubin (2.9 mg/dl), LDH (462 U/L), and ‐ Inflammation parameters: Ferritin or D‐dimer were elevated at 426 and 726 ng/ml, respectively |
‐Treatment with prednisone improved blood factors and Hb level. ‐ Seventh days before the second of the vaccine, prednisone dose was reduced. ‐ 2 days after the second dose of vaccine, same symptoms, and laboratory data observed. ‐ Prednisone dose was then increased causing improvement of symptoms and laboratory parameters, |
23 |
| Italy (2) b | Cold AIHA | M‐59 | Moderna |
‐ 1 days after second dose. ‐ Fever, dark urine and jaundice. |
‐ Hb drop from 10.1 to 6.8 g/dl and LDH elevation (1.8 ×ULN) 5 days after the second dose of moderna vaccine. | Low levels of complement components: C3 level was 55 mg/dl and C4 was undetectable. |
‐Treatment with prednisone and erythropoietin stabilized Hb at about 8.2 g/dl. ‐ 2 weeks later, rituximab was used with progressive and full recovery. |
24 |
| Italy (3) b | Warm AIHA | F‐79 | Pfizer‐BioNTech |
‐ After first dose. |
‐ Hb decrease from 10.4 to 9.1 g/dl (LDH 1.2 to 1.7 × ULN) after the first dose of Pfizer vaccine. | Not reported. | She need a slight increase of steroid dose (to 5 mg day prednisone) and remained stable following the second dose. | 25 |
| Italy (4) b | Warm AIHA | M‐73 | Moderna | ‐ 7 days after first dose. | ‐ Hb decrease from 13.9 to 9.1 g/dl, LDH 1.1 to 1.6 × ULN. | Not reported. | Treatment with prednisone 0.5 mg/kg day cause prompt response. | |
| Italy (5) b | Cold AIHA | M‐77 | Moderna | ‐ 7 days after first dose. | ‐ Hb drop from 9.3 to 7.2 g/dl. | Not reported. | Treatment was done with steroids, rituximab, and erythropoietin. | |
| Italy (6) b | Warm AIHA | M‐73 | Pfizer‐BioNTech | ‐ 5 days after second dose. | ‐ Hb drop from 14 to 7.4 g/dl, LDH 1.1 to 2.3 × ULN. | Not reported. | Treatment with high dose intravenous steroids improved symptoms about 1 week. | |
| Philippines (7) c | Warm AIHA | F‐33 | Moderna |
‐ 2 days after booster dose. ‐ Dizziness, generalized weakness and pallor. |
‐ Hb: 5.2 g/dl, high reticulocyte counts on the peripheral blood smear. ‐ DAT: positive for IgG and C3. |
‐ Elevated LDH and hyperferritinemia. | An intravenous steroid was administered to the patient. To relieve the anemia symptoms, packed red blood cells were transfused. During the hospitalization, hematologic indices steadily increased. | 26 |
Abbreviations: DAT, direct antiglobulin test; LDH, lactate dehydrogenase.
The patient had a history of cold agglutinin disease (CAD) in 2016 that had been improved using corticosteroids.
The patients suffered from mentioned AIHA before COVID‐19 vaccination.
Primary vaccination using an inactivated vaccine had no adverse effects.