Autoimmune Hemolytic Anemia After Inactivated Virus COVID-19 Vaccination: A Report of 2 Cases

Somchai Insiripong; Tanakorn Anantasetagoon; Likhasit Sanglutong

doi:10.33165/rmj.2022.45.3.256357

Authors

Somchai Insiripong Department of Medicine, Saint Mary’s Hospital, Nakhon Ratchasima, Thailand
Tanakorn Anantasetagoon Department of Medicine, Saint Mary’s Hospital, Nakhon Ratchasima, Thailand
Likhasit Sanglutong Department of Medicine, Bangkok Hospital Muangraj, Ratchaburi, Thailand

DOI:

https://doi.org/10.33165/rmj.2022.45.3.256357

Keywords:

Autoimmune hemolytic anemia, Inactivated virus COVID-19 vaccine, Shinopham

Abstract

Very few cases of autoimmune hemolytic anemia (AIHA) have been reported after mRNA COVID-19 vaccinations. But herein we found 2 cases of AIHA after inactivated virus COVID-19 vaccination. Case 1: a 47-year-old Thai woman suffered from malaise, fatigue, and feverish feeling since the evening of the day of the first dose of inactivated virus COVID-19 vaccination (Sinopharm). She did not have any serious health problem prior this illness. Physical examination revealed marked pallor and body temperature was 38.1°C. Blood tests showed hemoglobin (Hb) 55 g/L, white blood cell (WBC) 12.2 × 10⁹/L, platelet 310 × 10⁹/L, nucleated red blood cell (RBC) 8/100 WBC, reticulocyte count 25.0%, direct antiglobulin test-4+ positive, indirect antiglobulin test-2+ positive. She was diagnosed with severe AIHA and well responsive to steroid therapy. Case 2: a 78-year-old Thai woman felt fatigue without fever 3 days after the second dose of inactivated virus COVID-19 vaccine (Sinopharm). Her underlying disease was anemia of the elderly with alpha thalassemia-1 heterozygosity. Her averaged Hb concentration before transfusion was 85 ± 3 g/L and she always needed transfusion every 2 months. Physical examination revealed only pallor. Blood test showed Hb 79 g/L, WBC 3.7 ×10⁹/L, platelet 104 × 10⁹/L, direct antiglobulin test-4+ positive, indirect antiglobulin test-4+ positive. She was diagnosed with AIHA and treated with cyclophosphamide and blood transfusion. Although the association between the inactivated virus COVID-19 vaccination and AIHA could not be simply concluded and the mix-and-match combination of different COVID-19 vaccines is promoted by Thai government, both of our patients chose to postpone the next dose of any kind of COVID-19 vaccine.

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