Aplastic Anemia Following COVID-19 Vaccination: A Systematic Review of Case Reports and Case Series
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Abstract
Aplastic anemia (AA) is the prototypical bone marrow failure syndrome due to the destruction of hematopoietic stem cells by cytotoxic T cells. According to case reports, vaccines could lead to the development of AA. We conducted the present systematic review to evaluate cases of AA following vaccination against coronavirus disease (COVID-19).
We searched the following databases: PubMed, Scopus, and EMBASE in English, Portuguese, and Spanish languages until April 24, 2023. Published reports and case series on the occurrence of AA following vaccination against COVID-19 were included. The Joanna Brigs Institute was used to assess study quality and risk of bias.
Six studies were selected from 102 research studies and data were extracted according to the inclusion criteria. All case reports and case series reported the occurrence of AA following COVID-19 vaccination. AA events were mainly observed in vaccines with messenger ribonucleic acid technology (Moderna; Pfizer-BioNTech). AA was diagnosed by bone marrow biopsy and severity was determined by Camitta criteria.
All cases of AA were properly diagnosed. The sample size was small; therefore, further investigations are required to demonstrate and elucidate the complete pathophysiological mechanisms of AA development after receiving COVID-19 vaccination.
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19. Cecchi N, Giannotta JA, Barcellini W, Fattizzo B. A case of severe aplastic anaemia after SARS‐CoV‐2 vaccination. Br J Haematol. 2022; 196(6): 1334-6.
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21. Sridhara S, Nair R, Stanek M. Severe Aplastic Anemia After Receiving SARS-CoV-2 Moderna mRNA Vaccination. J Hematol. 2022; 11(1): 34-9.
22. Fazlollahi A, Zahmatyar M, Noori M, Nejadghaderi SA, Sullman MJM, Shekarriz-Foumani R, et al. Cardiac complications following mRNA COVID-19 vaccines: A systematic review of case reports and case series. Rev Med Virol. 2022; 32(4): e2318.
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24. Fatima Z, Reece BRA, Moore JS, Means RT. Autoimmune Hemolytic Anemia After mRNA COVID Vaccine. J Investig Med High Impact Case Rep. 2022; 10: 23247096211073256.
25. Gadi SRV, Brunker PAR, Al-Samkari H, Sykes DB, Saff RR, Lo J, et al. Severe autoimmune hemolytic anemia following receipt of SARS-CoV-2 mRNA vaccine. Transfusion (Paris). 2021; 61(11): 3267-71.
26. Hidaka D, Ogasawara R, Sugimura S, Fujii F, Kojima K, Nagai J, et al. New-onset Evans syndrome associated with systemic lupus erythematosus after BNT162b2 mRNA COVID-19 vaccination. Int J Hematol. 2022; 115(3): 424-7.
27. Rysava R, Peiskerova M, Tesar V, Benes J, Kment M, Szilágyi Á, et al. Atypical hemolytic uremic syndrome triggered by mRNA vaccination against SARS-CoV-2: Case report. Front Immunol. 2022; 13: 1001366.
28. Kouhpayeh H, Ansari H. Adverse events following COVID-19 vaccination: A systematic review and meta-analysis. Int Immunopharmacol. 2022; 109: 108906.
29. Angelini P, Kavadas F, Sharma N, Richardson SE, Tipples G, Roifman C, et al. APLASTIC ANEMIA FOLLOWING VARICELLA VACCINE. Pediatr Infect Dis J. 2009; 28(8): 746.
30. Donnini I, Scappini B, Guidi S, Longo G, Bosi A. Acquired severe aplastic anemia after H1N1 influenza virus vaccination successfully treated with allogeneic bone marrow transplantation. Ann Hematol. 2012; 91(3): 475-6.
31. Röth A, Bertram S, Schroeder T, Haverkamp T, Voigt S, Holtkamp C, et al. Acquired aplastic anemia following SARS‐CoV‐2 vaccination. Eur J Haematol. 2022; 109(2): 186-94.
2. Urbanowicz I, Nahaczewska W, Celuch B. Narrative review of aplastic anemia—the importance of supportive treatment. Ann Palliat Med. 2021; 10(1): 69499-699.
3. Shallis RM, Ahmad R, Zeidan AM. Aplastic anemia: Etiology, molecular pathogenesis, and emerging concepts. Eur J Haematol. 2018; 101(6): 711-20.
4. Jaime-Pérez JC, González-Treviño M, Gómez-Almaguer D. Pregnancy-associated aplastic anemia: a case-based review. Expert Rev Hematol. 2021; 14(2): 175-84.
5. Sweeney R, Esmail F, Mirza KM, Nand S. Hypercellular bone marrow in aplastic anemia: A case report of two patients. Clin Case Rep. 2021; 9(11): e04845.
6. Durrani J, Maciejewski JP. Idiopathic aplastic anemia vs hypocellular myelodysplastic syndrome. Hematol Am Soc Hematol Educ Program. 2019; 2019(1): 97-104.
7. Giudice V, Selleri C. Aplastic anemia: Pathophysiology. Semin Hematol. 2022; 59(1): 13-20.
8. Killick SB, Bown N, Cavenagh J, Dokal I, Foukaneli T, Hill A, et al. Guidelines for the diagnosis and management of adult aplastic anaemia. Br J Haematol. 2016; 172(2): 187-207.
9. Patel BA, Townsley DM, Scheinberg P. Immunosuppressive therapy in severe aplastic anemia. Semin Hematol. 2022; 59(1): 21-9.
10. WHO Coronavirus (COVID-19) Dashboard. Geneva: World Health Organization; 2023 [accessed 3 April 2023]. Available at: https://covid19.who.int.
11. Li M, Wang H, Tian L, Pang Z, Yang Q, Huang T, et al. COVID-19 vaccine development: milestones, lessons and prospects. Signal Transduct Target Ther. 2022; 7: 146.
12. Ajmera K, Bansal R, Wilkinson H, Goyal L. Gastrointestinal Complications of COVID-19 Vaccines. Cureus. 2022; 14(4): e24070.
13. Tabata S, Hosoi H, Murata S, Takeda S, Mushino T, Sonoki T. Severe aplastic anemia after COVID-19 mRNA vaccination: Causality or coincidence? J Autoimmun. 2022; 126: 102782.
14. Woo S, Kim B, Lee SC, Kim MS, Yoon YA, Choi YJ. Very severe immune aplastic anemia after mRNA vaccination against COVID-19 responds well to immunosuppressive therapy: clinical characteristics and comparison to previous reports. Hematol Amst Neth. 2022; 27(1): 1191-5.
15. Chen CY, Chen TT, Hsieh CY, Lien MY, Yeh SP, Chen CC. Case reports of management of aplastic anemia after COVID-19 vaccination: a single institute experience in Taiwan. Int J Hematol. 2023; 117(1): 149-52.
16. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372: n71.
17. Rethlefsen ML, Kirtley S, Waffenschmidt S, Ayala AP, Moher D, Page MJ, et al. PRISMA-S: an extension to the PRISMA Statement for Reporting Literature Searches in Systematic Reviews. Syst Rev. 2021; 10(1): 39.
18. Lockwood C, Munn Z, Porritt K. Qualitative research synthesis: methodological guidance for systematic reviewers utilizing meta-aggregation. Int J Evid Based Healthc. 2015; 13(3): 179-87.
19. Cecchi N, Giannotta JA, Barcellini W, Fattizzo B. A case of severe aplastic anaemia after SARS‐CoV‐2 vaccination. Br J Haematol. 2022; 196(6): 1334-6.
20. Wang X, Laczko D, Caponetti GC, Rabatin S, Babushok DV. Severe aplastic anaemia after serial vaccinations for SARS‐CoV‐2, pneumococcus and seasonal influenza. EJHaem. 2022; 3(3): 983-8.
21. Sridhara S, Nair R, Stanek M. Severe Aplastic Anemia After Receiving SARS-CoV-2 Moderna mRNA Vaccination. J Hematol. 2022; 11(1): 34-9.
22. Fazlollahi A, Zahmatyar M, Noori M, Nejadghaderi SA, Sullman MJM, Shekarriz-Foumani R, et al. Cardiac complications following mRNA COVID-19 vaccines: A systematic review of case reports and case series. Rev Med Virol. 2022; 32(4): e2318.
23. Mingot-Castellano ME, Butta N, Canaro M, Gómez del Castillo Solano M del C, Sánchez-González B, Jiménez-Bárcenas R, et al. COVID-19 Vaccines and Autoimmune Hematologic Disorders. Vaccines. 2022; 10(6): 961.
24. Fatima Z, Reece BRA, Moore JS, Means RT. Autoimmune Hemolytic Anemia After mRNA COVID Vaccine. J Investig Med High Impact Case Rep. 2022; 10: 23247096211073256.
25. Gadi SRV, Brunker PAR, Al-Samkari H, Sykes DB, Saff RR, Lo J, et al. Severe autoimmune hemolytic anemia following receipt of SARS-CoV-2 mRNA vaccine. Transfusion (Paris). 2021; 61(11): 3267-71.
26. Hidaka D, Ogasawara R, Sugimura S, Fujii F, Kojima K, Nagai J, et al. New-onset Evans syndrome associated with systemic lupus erythematosus after BNT162b2 mRNA COVID-19 vaccination. Int J Hematol. 2022; 115(3): 424-7.
27. Rysava R, Peiskerova M, Tesar V, Benes J, Kment M, Szilágyi Á, et al. Atypical hemolytic uremic syndrome triggered by mRNA vaccination against SARS-CoV-2: Case report. Front Immunol. 2022; 13: 1001366.
28. Kouhpayeh H, Ansari H. Adverse events following COVID-19 vaccination: A systematic review and meta-analysis. Int Immunopharmacol. 2022; 109: 108906.
29. Angelini P, Kavadas F, Sharma N, Richardson SE, Tipples G, Roifman C, et al. APLASTIC ANEMIA FOLLOWING VARICELLA VACCINE. Pediatr Infect Dis J. 2009; 28(8): 746.
30. Donnini I, Scappini B, Guidi S, Longo G, Bosi A. Acquired severe aplastic anemia after H1N1 influenza virus vaccination successfully treated with allogeneic bone marrow transplantation. Ann Hematol. 2012; 91(3): 475-6.
31. Röth A, Bertram S, Schroeder T, Haverkamp T, Voigt S, Holtkamp C, et al. Acquired aplastic anemia following SARS‐CoV‐2 vaccination. Eur J Haematol. 2022; 109(2): 186-94.
| Files | ||
| Issue | Vol 18 No 3 (2024) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijhoscr.v18i3.16111 | |
| Keywords | ||
| Anemia Aplastic anemia COVID-19 Vaccines SARS-CoV-2 Vaccines | ||
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How to Cite
1.
Cahuapaza-Gutierrez N, Campos-Escalante T. Aplastic Anemia Following COVID-19 Vaccination: A Systematic Review of Case Reports and Case Series. Int J Hematol Oncol Stem Cell Res. 2024;18(3):297-305.
