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New-onset aplastic anemia after SARS-CoV-2 vaccination

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Abstract

Aplastic anemia (AA) is a rare autoimmune disease. Drugs, viruses, and radiation are among the most common etiologic factors, and most cases have immune pathophysiology. SARS-CoV-2 vaccines have been linked with rare side effects, including cases of acquired aplastic anemia. Here we review all the reported cases of new-onset AA after SARS-CoV-2 vaccination, and discuss their clinical characteristics and management. 18 patients in these case reports had a median age of 58 years. The time from vaccination to onset of aplastic anemia ranged from 1 day to 7 months, with a median of 2.5 weeks. Seventeen patients were diagnosed with severe or very severe aplastic anemia post-vaccination and all patients received standard treatments for acquired aplastic anemia. Seventeen patients achieved a complete or partial response and only 1 patient died. Aplastic anemia can be considered a very rare SARS-CoV-2 vaccine-related adverse event, although a causative relationship has not been proven. Reporting cases of such uncommon post-vaccination events could help clinicians to consider aplastic anemia when pancytopenia is observed after vaccination. The benefits of SARS-Cov-2 vaccination are established, and reports of rare events serve only to increase awareness in daily clinical practice.

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Abbreviations

AA:

Aplastic anemia

ACST:

Allogeneic stem cell transplantation

AE:

Adverse event

ANC:

Absolute neutrophil count

ATG:

Anti-thymocyte globulin

BM:

Bone marrow

Hb:

Hemoglobin

HLA:

Human leukocyte antigen

IST:

Immunosuppressive therapy

PLT:

Platelets

PNH:

Paroxysmal nocturnal Hemoglobinuria

SARS-CoV-2:

Severe acute respiratory syndrome coronavirus 2

SCT:

Stem cell transplantation

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Authors and Affiliations

  1. Department of Pediatrics, National and Kapodistrian University of Athens Medical School, Athens, Greece

    Elena Chatzikalil & Antonis Kattamis

  2. First Department of Internal Medicine, National and Kapodistrian University of Athens Medical School, Athens, Greece

    Panagiotis Diamantopoulos

  3. Internal Medicine-Hematology, University of Patras Medical School, 26500, Rion, Greece

    Elena E. Solomou

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  1. Elena Chatzikalil
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  2. Antonis Kattamis
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  3. Panagiotis Diamantopoulos
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  4. Elena E. Solomou
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Correspondence to Elena E. Solomou.

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Chatzikalil, E., Kattamis, A., Diamantopoulos, P. et al. New-onset aplastic anemia after SARS-CoV-2 vaccination. Int J Hematol 118, 667–681 (2023). https://doi.org/10.1007/s12185-023-03666-z

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  • DOI: https://doi.org/10.1007/s12185-023-03666-z

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