Researchers show that patients with pre-existing autoimmune hemolytic anemia (AIHA), including cold agglutinin disease (CAD), should be closely monitored after receiving vaccines against the severe acute respiratory syndrome-2 virus (SARS-CoV-2; COVID-19), as published in Hematology, Transfusion and Cell Therapy.

The report highlighted the case of a 33-year-old female with previously diagnosed AIHA who had severe anemia in response to receiving a booster with the mRNA-1273 vaccine (Moderna).

“Various case reports have been published regarding AIHA after COVID-19 vaccination, all of whom received the mRNA vaccine. Hemolysis was noted in the majority after the first dose, but was also seen after the second dose,” the authors said.

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Most of the previously reported cases had symptom onset occur between 2 and 19 days with 1 case occurring 3 months postvaccination. The patient reported in the current case developed flu-like symptoms and injection-site pain 1 day after vaccination.

Read more about CAD epidemiology

After 2 days, she developed dizziness, generalized weakness, and pallor. A complete blood count revealed severe anemia and she was admitted to the hospital 3 days after receiving the booster.

All patients were treated with immunosuppression with corticosteroids including either prednisone or methylprednisolone. Most patients also received treatment with packed red blood cells to help alleviate the anemia.

In contrast to the previously reported cases after vaccination, this patient already had a history of AIHA and did not have a reaction to their primary round of vaccination. The initial vaccination was performed using an inactivated virus vaccine (Sinovac/Coronavac) while the booster, to which they had a reaction, was with an mRNA vaccine.

“This case showed the possibility of recurrence of the AIHA shortly after the COVID-19 vaccination. Although it cannot definitely determine any causation, we cannot exclude the possibility of the patient’s mRNA vaccination as an inciting or precipitating factor,” the authors concluded.

“Patients with pre-existing autoimmune cytopenia should be closely monitored.”


Mesina FZ. Severe relapsed autoimmune hemolytic anemia after booster with mRNA-1273 COVID-19 vaccine. Hematol Transfus Cell Ther. Published online May 30, 2022. doi:10.1016/j.htct.2022.05.001