Severe Acute Hemolytic Anemia Post Covid Vaccination

ABSTRACT

Case Report A 26-year-old woman with a history of warm autoimmune hemolytic anemia, immune thrombocytopenia, triple positive antiphospholipid syndrome, and chronic migraine presented to the emergency department with worsening generalized fatigue for one week associated with headache, dyspnea on exertion, nausea, vomiting and lightheadedness. Of note, she had received her second dose of mRNA COVID-19 vaccine 4 days prior to presentation. On admission, patient was found to be severely anemic with a hemoglobin of 4.3g/dL which is decreased from her baseline hemoglobin of 9-10.5g/dL;however, W-AIHA precluded the administration of blood product until adequate blood with the appropriate antibodies could be acquired. During the hospitalization, hemoglobin decreased to 3.3g/dL. Patient was then administered the most compatible blood product which she tolerated well. Hematology was consulted who started the patient on hydroxychloroquine, high dose methylprednisolone, and Intravenous Immunoglobulin (IVIG). Throughout the admission, the patient remained asymptomatic. After 2 days of IVIG, three days of high dose glucocorticoids, and one unit of packed red blood cells, the patient's hemoglobin increased to 7.2g/dL. Patient was discharged home on prednisone taper and hydroxychloroquine. Conclusion(s) Episodes of hemolytic anemia after either the first or second dose of mRNA COVID vaccines are rare and have occurred in patients with known hematological pathology as well as patients without any history of hematologic or immunologic disorders. When taking the history of patients presenting with hemolytic anemia, it is important to query recent vaccinations as, while rare, mRNA COVID vaccine may well be the etiology. While this ultimately will likely not change patient management, this information would be beneficial for further study.