Progression of hemolysis in a patient with hereditary spherocytosis after the second dose of COVID-19 mRNA vaccine: Correspondence

KEYWORDS:

• Hemolysis
• hereditary spherocytosis
• COVID-19
• mRNA vaccine

Dear Editor

We read Nomura’s paper¹ with great interest and would like to share ideas on this paper. Nomura reported a case of progression of hemolysis in a patient with hereditary spherocytosis (HS) after the second dose of COVID-19 mRNA vaccine and further performed a review.¹ As we know, HS results in an increased risk of hemolysis with cellular stress and splenic clearance. Patients and care providers are educated on the importance of monitoring for hemolysis during febrile episodes to avoid an array of complications from acute anemia. Until now, only three reports documented hemolytic anemia could be triggered by SARS-CoV-2 in HS patients.^2–4 But Nomura reported¹ this case of progression of hemolysis in a patient with HS after the second dose of COVID-19 mRNA vaccine. In Nomura’s examination of the literature data, there have been an increasing number of case reports of vaccine-induced exacerbation of hematological diseases, especially idiopathic thrombocytopenic purpura. However, we would like to give some comments.

First, it is typically challenging to pinpoint the specific clinical association because there is little clinical information on the health and immunological status of vaccination recipients before injection. The patient’s comorbidities may have contributed to the problem, and comorbidities exist even though they are rarely taken into account in published studies. Therefore, are there any comorbidities in this HS patient? This patient may have co-occurring ailments in addition to her obvious HS illness. Additionally, Nomura reported that her family history indicated that her father, older brother, and younger sister had also been diagnosed with HS, how about the administration of the COVID-19 mRNA vaccine and the follow-up of her family members.

Second, studies have shown the autoimmunity of people who were unwilling to receive the COVID-19 vaccine because of fears of additional adverse events. And case series of Guillain-Barré syndrome, cutaneous vasculitis, reactive arthritis and immune-medicated disease flare from mRNA are continuously emerging.⁵ Thus, how about the autoimmunity status of this young HS patient and her family members, which is also crucial to establish the connection on the COVID-19 vaccine-induced exacerbation of hematological diseases. Therefore, an antinuclear antibody test to assess the effect of autoimmunity must be performed before the COVID-19 vaccine.

Finally, hematologists should be aware of this rare but potentially severe adverse event in HS patients, and co-morbidity or an underlying pathological condition should be investigated before the COVID-19 vaccine in the case of uncontrolled hemolytic anemia.

Author contribution

Wei Pan, Diao Yu, Na Shi and Zheng Bao discussed and wrote the manuscript. All authors reviewed this manuscript and agreed to submit this manuscript.

Consent from all authors

All authors reviewed this manuscript and agreed to submit this manuscript.

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