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Severe refractory warm autoimmune haemolytic anaemia after the SARS-CoV-2 Pfizer-BioNTech vaccine (BNT162b2 mRNA) managed with emergency splenectomy and complement inhibition with eculizumab.
Jackson, Emma Marguerite; Harper, Simon; Webb, Gwilym J; Thomas, Will.
  • Jackson EM; Clinical School, University of Cambridge, Cambridge, UK.
  • Harper S; Hepatopancreaticobiliary Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
  • Webb GJ; Department of hepatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
  • Thomas W; Department of haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK w.thomas1@nhs.net.
BMJ Case Rep ; 15(8)2022 Aug 31.
Article in English | MEDLINE | ID: covidwho-2019952
ABSTRACT
A male in his teens with a history of liver transplant for biliary atresia (aged 2 years) and autoimmune haemolytic anaemia (AIHA, aged 6 years) presented with jaundice, dark urine, fatigue and chest discomfort that began 48 hours after the first dose of SARS-CoV-2 Pfizer-BioNTech vaccine (BNT162b2 mRNA). Investigations revealed a warm AIHA picture. Over 4 weeks the patient developed life-threatening anaemia culminating in haemoglobin of 35 g/L (after transfusion), lactate dehydrogenase of 1293 units/L and bilirubin of 228 µmol/L, refractory to standard treatment with corticosteroids and rituximab. An emergency splenectomy was performed that slowed haemolysis but did not completely ameliorate it. Eculizumab, a terminal complement pathway inhibitor, was initiated to arrest intravascular haemolysis and showed a favourable response. AIHA is rare but described after the SARS-CoV-2 Pfizer-BioNTech vaccine. This case highlights the rare complication of AIHA, the use of emergency splenectomy for disease control, and the use of eculizumab.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / BNT162 Vaccine / Anemia, Hemolytic, Autoimmune Type of study: Case report / Observational study / Prognostic study Topics: Long Covid / Vaccines Limits: Adolescent / Humans / Male Language: English Year: 2022 Document Type: Article Affiliation country: Bcr-2022-250774

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / BNT162 Vaccine / Anemia, Hemolytic, Autoimmune Type of study: Case report / Observational study / Prognostic study Topics: Long Covid / Vaccines Limits: Adolescent / Humans / Male Language: English Year: 2022 Document Type: Article Affiliation country: Bcr-2022-250774