ABSTRACT
During an acute SARS-CoV-2 infection, a diagnosis of Aplastic Anaemia associated with Paroxysmal Nocturnal Haemoglobinuria (AA/PNH) was made in a 78-year-old woman who had presented to the emergency department with severe pancytopenia. It is possible that she had subclinical AA/PNH that was unmasked during the acute COVID-19 infection, but we can also suspect a direct role of the virus in the pathogenesis of the disease, or we can hypothesize that COVID-19 infection changed the phosphatidylinositol glycan class A (PIGA) gene pathway.
Subject(s)
Anemia, Aplastic , COVID-19 , Hemoglobinuria, Paroxysmal , Pancytopenia , Aged , Anemia, Aplastic/complications , Anemia, Aplastic/diagnosis , Anemia, Aplastic/genetics , COVID-19/complications , Female , Glycosylphosphatidylinositols , Hemoglobinuria, Paroxysmal/complications , Hemoglobinuria, Paroxysmal/diagnosis , Humans , Pancytopenia/complications , SARS-CoV-2ABSTRACT
We present a 67-year-old woman who developed progressive pancytopenia over 10 months, concomitant with administration of severe adult respiratory syndrome coronavirus-2 (SARS-CoV-2), pneumococcal and influenza vaccines. She developed mild leukopenia â¼2 weeks after the SARS-CoV-2 mRNA vaccine sequence, with progressive symptoms after subsequent vaccines, eventually developing severe aplastic anaemia (SAA). While there have been several reports of vaccine-related SAA, at time of submission, our case is the first reported to develop after the Moderna mRNA SARS-CoV-2 vaccine, as well as the first to document the gradual development of SAA over the course of many vaccine exposures. Physicians should be cognizant of vaccine-associated SAA, considering current widespread coronavirus disease 2019 vaccination efforts.
ABSTRACT
A 47-year-old male with paroxysmal nocturnal haemoglobinuria (PNH) controlled with routine ravulizumab administration suffered a massive haemolytic crisis due to choledocholithiasis. Laparoscopic cholecystectomy was performed 6 weeks after a regular ravulizumab infusion. After surgery, the patient presented with anaemia without marked elevation in lactate dehydrogenase and required two blood transfusions. Tumour necrosis factor-α increased more than twofold with reticulocyte suppression after surgery, suggesting the involvement of myelosuppressive cytokines. This case suggests that laparoscopic surgery may be safely performed in patients with PNH receiving ravulizumab maintenance treatment. However, attention should be paid to postoperative anaemia, regardless of breakthrough haemolysis.