Department of Immunology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran.
Molecular Medicine Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
Int J Lab Hematol. 2023 Apr;45(2):145-155. doi: 10.1111/ijlh.13978. Epub 2022 Oct 8.
Autoimmune hemolytic anemia (AIHA) is caused by the production of autoantibodies against RBCs. COVID-19 vaccines can reduce the risk of severe disease, however, various adverse effects such as AIHA were observed following vaccination. This review aimed to assess the relationship of AIHA and COVID-19 vaccination using the PRISMA guidelines. Among 18 cases included in this review, new post-vaccination AIHA development was reported in 11 patients (7 women and 4 men) with a median age of 67.0 years. In 7 of 11 and 3 of 11 cases, the onset of symptoms occurred after first and second vaccine dose with median times of 7 and 14 days, respectively. In 1 of 11 cases, the AIHA occurred on Day 17 after booster vaccination. Ten of 11 and 1 of 11 AIHA patients received mRNA- and vector-based vaccine, respectively. After vaccination, 9 of 11, 1 of 11, and 1 of 11 AIHA patients developed warm IgG, cold IgM, and mixed autoantibodies against RBCs, respectively. Significant AIHA exacerbation was reported in seven patients (four women and three men) with a median age of 73.0 years. In 4 of 7 and 2 of 7 exacerbated AIHA cases, the onset of symptoms occurred after first and second vaccine dose with median times of 7 and 3 days, respectively. In 1 of 7 exacerbated AIHA cases, the onset of symptoms was observed on Day 2 after booster vaccination. All exacerbated AIHA cases received mRNA-based vaccines; 3 of 7 and 4 of 7 exacerbated AIHA cases developed IgG and IgM against RBCs, respectively. This review provides a comprehensive explanation regarding the AIHA development and exacerbation after COVID-19 vaccination.
自身免疫性溶血性贫血（AIHA）是由针对 RBC 的自身抗体产生引起的。COVID-19 疫苗可以降低患重病的风险，然而，接种疫苗后观察到了各种不良反应，如 AIHA。本综述旨在使用 PRISMA 指南评估 AIHA 与 COVID-19 疫苗接种的关系。在本综述中纳入的 18 例病例中，有 11 例（7 名女性和 4 名男性）新发生了接种后 AIHA，中位年龄为 67.0 岁。在 11 例中的 7 例和 11 例中的 3 例中，症状分别在第一剂和第二剂疫苗后出现，中位时间分别为 7 天和 14 天。在 11 例中的 1 例中，AIHA 发生在加强疫苗接种后第 17 天。在 11 例 AIHA 患者中有 10 例和 1 例分别接受了 mRNA 疫苗和基于载体的疫苗。接种疫苗后，在 11 例 AIHA 患者中有 9 例、1 例和 1 例分别产生了针对 RBC 的温 IgG、冷 IgM 和混合自身抗体。在 7 例（4 名女性和 3 名男性）AIHA 加重的患者中报告了显著的 AIHA 加重，中位年龄为 73.0 岁。在 7 例 AIHA 加重病例中有 4 例和 2 例分别在第一剂和第二剂疫苗后出现症状，中位时间分别为 7 天和 3 天。在 7 例 AIHA 加重病例中有 1 例在加强疫苗接种后第 2 天出现症状。所有 AIHA 加重病例均接受了基于 mRNA 的疫苗；在 7 例 AIHA 加重病例中有 3 例和 4 例分别产生了针对 RBC 的 IgG 和 IgM。本综述提供了关于 COVID-19 疫苗接种后 AIHA 发生和加重的全面解释。
