A team of Italian researchers discovered that the flares experienced by patients with autoimmune cytopenias, such as cold agglutinin disease, were manageable after receiving SARS-CoV-2 vaccines. The benefit of receiving the vaccines from Pfizer-BioNtech, Moderna, and Astra-Zeneca far outweigh any potential risks, according to a letter published in the American Journal of Hematology

Because of scientists’ limited understanding of the immunology underpinning SARS-CoV-2, there is some anxiety within the medical community about how SARS-CoV-2 and the vaccinations developed to neutralize it will interact with the immune system of patients with autoimmune cytopenias.

The authors of this letter explained, “Autoimmune cytopenias are highly heterogeneous conditions with variable severity and a clinical course. They are marked by several relapses often triggered by immune-activating events (infections, traumas, surgery) including vaccines.” 

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The Italian research team hence decided to study 108 patients with autoimmune cytopenias. Among the 108 cases were 41 warm-type autoimmune hemolytic anemia (AIHA), 15 cold-type AIHA, 38 immune thrombocytopenia, 7 autoimmune neutropenia, and 7 aplastic anemia. All of the patients received SARS-CoV-2 vaccinations between March and June 2021. The researchers monitored the hematologic trends of these patients at baseline, after the first vaccine dose, and after the second vaccine dose. 

Read more about cold agglutinin disease etiology

The results demonstrated that SARS-CoV-2 vaccination may be associated with a clinically significant decrease of hematologic values in 7.4% of patients with AIHA and immune thrombocytopenia, however, they were quickly rescued by treatment adaptation. The researchers also observed a decrease in hematologic values in about 10% of AIHA patients and 20% of immune thrombocytopenia patients that required no treatment change.

The research team also discovered that recrudescences in patients with autoimmune cytopenias were unpredictable; in other words, they occurred independently from vaccine doses, regardless of vaccine type. 

The findings of this study were consistent with other studies that demonstrated that even if exacerbations occur in patients with autoimmune cytopenias after receiving a vaccine dose, the patient’s condition can be improved rapidly with steroids and transfusion support.


Fattizzo B, Giannotta JA, Cecchi N, Barcellini W. SARS-CoV-2 vaccination in patients with autoimmune cytopenias: the experience of a reference centerAm J Hematol. Published online September 3, 2021. doi:10.1002/ajh.26345