Abstract
Exacerbations or de novo cases of autoimmune cytopenias secondary to COVID-19 infection and vaccines have been frequently reported, whilst the association with aplastic anemia (AA) or pure red cell aplasia (PRCA) is rarer. We describe eight AA patients (6 severe/2 non-severe) diagnosed after a median of 2.3 months from the last dose of anti-SARS-CoV-2 vaccine. All required immunosuppression and about 70% responded at 6 months. By immune-histochemistry, bone marrow samples were negative for Spike protein whilst an abundant anti-IgM, anti-IgG, anti-C3, and anti-C4d immunoreactivity was observed. The comparison with bone marrow samples from AA patients diagnosed before COVID19 pandemics showed increased immunoglobulins and complement deposition in AA patients diagnosed after SARS-CoV-2 vaccine. Literature review showed 6 AA cases developing after SARS-CoV-2 infection and 10 after vaccine. A clear causative link is difficult to establish, but for the temporal association. Physiopathology seems more associated with a broader autoimmune activation than to a specific anti-Spike attack, although further investigation is needed.
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Authors
Bruno Fattizzo
SC Ematologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
Raffaella Pasquale SC Ematologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
Giorgio Aleberto Croci
SC Anatomia Paologica, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
Loredana Pettine SC Ematologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
Giulio Cassanello
SC Ematologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Onclology and Onco-hematology, University of Milan, Milan, Italy
Wilma Barcellini
SC Ematologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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