Very severe immune aplastic anemia after mRNA vaccination against COVID-19 responds well to immunosuppressive therapy: clinical characteristics and comparison to previous reports

Figures & data

Figure 1. (A) Bone marrow biopsy at the time of aplastic anemia diagnosis. (B) Bone marrow biopsy and (C) clot section at follow-up. (D) Changing blood count patterns in our patient. ** ANC, absolute neutrophil count; ATG, anti-thymocyte globulin; CsA, cyclosporin A; HB, hemoglobin; PLT, platelet; WBC, white blood cells.

Table 1. Clinical and laboratory features of patients with COVID-19-vaccine-induced aplastic anemia.

	Cecchi et al., 2021	Tobata et al., 2021	Sridhara et al., 2022	Roth et al., 2022 (4 cases of relapsed AA)	This patient
Age/gender	76/M	56/M	60/M	Median 53/all male	53/M
Type and frequency of COVID-19 vaccination	Pfizer-BioNTech, second	Pfizer-BioNTech, second	Moderna, second	Pfizer-BioNTech, second	Moderna, second
Onset time after vaccination	1 month	4 days	1 d	5–35 days	2 weeks
A
ANC count (x10^9/L)	0.46	0.008	0	1.14 - 2.54	0.1
Hemoglobin (g/L)	112	111	80	110–140	6.6
Reticulocyte count (x10^9/L)	38	5	4	37.1–70.7	10.6
Platelet count (x10^9/L)	3	11	1	7 - 78	2
Peripheral blood finding	No schistocytes or blasts	Not presented	No schistocytes or blasts	Not presented	No schistocytes or blasts
Bone marrow finding	10% cellularity with absence of blasts or dysplastic features	Hypocellular marrow	Hypocellular marrow (5% cellularity)	Hypocellular marrow (0-30% cellularity)	Hypocellular marrow (<5% cellularity)
Hematologic diagnosis	Severe AA	Severe AA	Severe AA	AA relapse	Severe AA
PNH clone	0.6% granulocytes and 0.03% erythrocytes	Not presented	No PNH clone		0.02% erythrocytes, 0.14% granulocytes, and 0.60% monocytes
Chromosome	Normal	Not presented	Normal	Not presented	45,X,-Y[4]/46,XY,t(11;14)(p10;p10)[3]/46,XY[13].
Treatment	IST	G-CSF, cyclosporine, eltrombopag Allogeneic HSCT	IST	IST IST and allogenic HSCT	Triple IST
Clinical course	Serum sickness and CMV infection Pancytopenic and transfusion-dependent at last follow-up	Skin grade 1 acute GVHD Neutrophil engraftment and complete chimerism after HSCT	Pneumonia, Enterococcus bacteremia and C.difficile enteritis Expired	Stable but persistent neutropenia and thrombocytopenia aspergillosis	Improved blood counts without transfusion and bone marrow cellularity

*AA, aplastic anemia; ANC, absolute neutrophil count; CMV, cytomegalovirus, G-CSF, granulocyte colony-stimulating factor; GVHD, graft-versus-host disease, HSCT, hematopoietic stem cell transplantation; IST, immunosuppressive therapy; PNH, paroxysmal nocturnal hematuria.

Cecchi N, Giannotta JA, Barcellini W, et al. A case of severe aplastic anaemia after SARS-CoV-2 vaccination. Br J Haematol. 2021.

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Sridhara S, Nair R, Stanek M. Severe aplastic anemia after receiving SARS-CoV-2 moderna mRNA vaccination. J Hematol. 2022;11(1):34–9. doi:10.14740/jh954.

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