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Abdallah J, Williams RG, Awada H, Raman G, Ozcan Y, Orland M, Mete M, Chen W, Gurnari C, Maciejewski JP, Bat T. Thrombocytosis and megakaryocyte changes associated with PRCA. Blood Adv 2024; 8:3058-3062. [PMID: 38564765 PMCID: PMC11215193 DOI: 10.1182/bloodadvances.2023012309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/28/2024] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Affiliation(s)
- Joelle Abdallah
- Division of Hematology and Oncology, UT Southwestern Medical Center, Dallas, TX
| | | | - Hussein Awada
- Translational Hematology and Oncology Research, Cleveland Clinic, Cleveland, OH
| | - Ganesh Raman
- Division of Hematology and Oncology, UT Southwestern Medical Center, Dallas, TX
| | | | - Mark Orland
- Translational Hematology and Oncology Research, Cleveland Clinic, Cleveland, OH
| | - Mutlu Mete
- Department of Computer Science, Texas A&M University-Commerce, Commerce, TX
| | - Weina Chen
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX
| | - Carmelo Gurnari
- Translational Hematology and Oncology Research, Cleveland Clinic, Cleveland, OH
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | - Taha Bat
- Division of Hematology and Oncology, UT Southwestern Medical Center, Dallas, TX
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2
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Fattizzo B, Pasquale R, Croci GA, Pettine L, Cassanello G, Barcellini W. Aplastic anemia after SARS-CoV-2 infection or vaccines: case series and literature review. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2024; 22:266-272. [PMID: 37677091 PMCID: PMC11073627 DOI: 10.2450/bloodtransfus.500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 05/29/2023] [Indexed: 09/09/2023]
Affiliation(s)
- Bruno Fattizzo
- SC Ematologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Onclology and Onco-hematology, University of Milan, Milan, Italy
| | - Raffaella Pasquale
- SC Ematologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio A. 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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3
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Youssef MAM, Ahmed ES, Kamal DT, Elsayh KI, Abdelfattah MA, Mahran HH, Embaby MM. Clinical Signs and Treatment of New-Onset Bone Marrow Failure Associated SARS-CoV-2 Infection in Children: A Single Institution Prospective Cohort Study. Mediterr J Hematol Infect Dis 2024; 16:e2024034. [PMID: 38468844 PMCID: PMC10927230 DOI: 10.4084/mjhid.2024.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 02/07/2024] [Indexed: 03/13/2024] Open
Abstract
Background Viral infections can cause direct and indirect damage to hematopoietic stem cells. The objectives of this study were to identify the frequency and severity of aplastic anemia in children infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as well as recognize the response to treatment. Methodology 13 children with newly diagnosed severe aplastic anemia were enrolled in this prospective clinical trial. Blood samples were obtained from all patients to detect SARS-CoV-2 antibodies, and nasopharyngeal swabs were collected for reverse-transcription Polymerase Chain Reaction to detect SARS-CoV-2 viruses. According to the laboratory results, patients were classified as having SARS-CoV-2 positive antibodies and SARS-CoV-2 negative antibodies. Both groups received combined cyclosporine (CsA) + Eltrombopag (E-PAG). The hematological response, either complete response (CR) or partial response (PR), no response (NR), and overall response (OR) rates of combined E-PAG + CsA treatment after 6 months were evaluated. Results Four children were recognized to have aplastic anemia and SARS-CoV-2 positive antibodies. Two patients fulfilled the hematological criteria for CR and no longer required transfusion of packed red blood cells (PRBCs) or platelets, and one had PR and was still PRBC transfusion-dependent but no longer required platelet transfusion. The remaining patient showed NR, and he had died before reaching the top of the HSCT waiting list. Moreover, six patients in the SARS-CoV-2 negative antibodies group had CR, while three patients had PR. The difference in ANC, Hg, and platelet counts between both groups was not significant. Conclusion The SARS-CoV-2 virus is added to several viral infections known to be implicated in the pathogenesis of aplastic anemia. Studies are needed to establish a definitive association and determine whether the response of bone marrow failure to standard therapy differs from that of idiopathic cases.
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Affiliation(s)
- Mervat A M Youssef
- Children Hospital, Hematology Unit, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - Dalia Tarik Kamal
- Clinical Pathology Department - Faculty of Medicine-Assiut University
| | - Khalid I Elsayh
- Children Hospital, Hematology Unit, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mai A Abdelfattah
- Children Hospital, Hematology Unit, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Hyam Hassan Mahran
- Children Hospital, Hematology Unit, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mostafa M Embaby
- Children Hospital, Hematology Unit, Faculty of Medicine, Assiut University, Assiut, Egypt
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4
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Aguilar JJ, Dhillon V, Balasubramanian S. Manifestation of Pancytopenia Associated with COVID-19 as Paroxysmal Nocturnal Hemoglobinuria (PNH) and Aplastic Anemia (AA). Hematol Rep 2024; 16:42-49. [PMID: 38247995 PMCID: PMC10801523 DOI: 10.3390/hematolrep16010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/29/2023] [Accepted: 01/10/2024] [Indexed: 01/23/2024] Open
Abstract
We report two cases of pancytopenia in patients after recovering from a mild COVID-19, now presenting as paroxysmal nocturnal hemoglobinuria (PNH) and aplastic anemia. These cases illustrate a common pathway whereby a viral trigger causes the clonal expansion of a hematological disorder. Although the association of both cases with COVID-19 is temporal and COVID-19 may be an incidental diagnosis, the growing evidence related to the hematological effects of SARS-CoV-2 infection highlights the need for further investigation into the hematological consequences of COVID-19, particularly in the post-pandemic era.
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Affiliation(s)
| | - Vikram Dhillon
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI 48201, USA;
| | - Suresh Balasubramanian
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI 48201, USA;
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5
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Wu X, Mo Y, Wen K, Ming R, Yin X, Hu L, Liu G, Lin G, Li W. Acquired aplastic anaemia after SARS-CoV-2 infection in China: a case report. Front Pediatr 2023; 11:1277540. [PMID: 38027266 PMCID: PMC10661920 DOI: 10.3389/fped.2023.1277540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Since the coronavirus disease 2019 (COVID-19) pandemic began, several research groups in different countries have described cases of aplastic anaemia (AA) after COVID-19 or COVID-19 vaccination. Here, we present the case of a patient with new-onset AA in Changsha, China, that was presumably associated with preceding severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We conducted an epidemiological assessment of the incidence rate of blood system diseases from July 1, 2022, to May 31, 2023, in the haematology department of the Second Xiangya Hospital of Central South University and Hunan Children's Hospital. The detection rates of AA and leukaemia in the first two months after the epidemic outbreak were higher than those before and during the outbreak. However, only the difference in the detection rate of leukaemia was statistically significant.
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Affiliation(s)
- Xiyan Wu
- Center for Reproductive Medicine, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China
| | - Yi Mo
- Department of Laboratory Medicine, Hunan Children’s Hospital, Changsha, China
| | - Kailiang Wen
- Medical Laboratory, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Rui Ming
- The Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, China
| | - Xinyu Yin
- The Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, China
| | - Liang Hu
- The Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, China
| | - Gang Liu
- The Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, China
| | - Ge Lin
- The Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, China
| | - Weina Li
- Department of Andrology, Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Changsha, China
- Scientific Research Department, Hunan Guangxiu Hi-Tech Life Technology Co., Ltd., Changsha, China
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6
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Kimura H, Furukawa M, Shiga Y, Kai T, Yasuda I, Katoh S, Sando E. Exacerbation of autoimmune hemolytic anemia associated with pure red cell aplasia after COVID-19: A case report. J Infect Chemother 2023:S1341-321X(23)00087-9. [PMID: 37044274 PMCID: PMC10084666 DOI: 10.1016/j.jiac.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/30/2023] [Accepted: 04/05/2023] [Indexed: 04/14/2023]
Abstract
Autoimmune hemolytic anemia (AIHA) and pure red cell aplasia (PRCA) are rare complications of coronavirus disease 2019 (COVID-19). Herein, we report the case of a 28-year-old Japanese man who showed severe AIHA exacerbation associated with PRCA after COVID-19. AIHA was diagnosed and maintained for 5 years. Approximately 4 weeks after COVID-19, the patient developed severe anemia (hemoglobin level, 3.4 g/dL). Laboratory test results confirmed hemolytic exacerbation of IgG-mediated warm-type AIHA. Despite the hemolysis phase, the bone marrow revealed extreme hypoplasia of erythroblasts with a decreased reticulocyte count, similar to that observed in patients with PRCA. During oral prednisolone treatment, the patient recovered from anemia and showed increased reticulocyte count and reduced hypoplasia of marrow erythroblasts. Exacerbation of AIHA and PRCA was triggered by COVID-19 because other causes were ruled out. Although this case report highlights that COVID-19 could lead to hematological complications such as AIHA and PRCA, the exact mechanisms remain unclear.
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Affiliation(s)
- Hideo Kimura
- Hematology, Kita-Fukushima Medical Center, 23-1 Aza-Higashi, Hakozaki, Date, Fukushima, 960-0502, Japan.
| | - Miki Furukawa
- Hematology, Kita-Fukushima Medical Center, 23-1 Aza-Higashi, Hakozaki, Date, Fukushima, 960-0502, Japan
| | - Yutaka Shiga
- Hematology, Kita-Fukushima Medical Center, 23-1 Aza-Higashi, Hakozaki, Date, Fukushima, 960-0502, Japan
| | - Tatsuyuki Kai
- Hematology, Kita-Fukushima Medical Center, 23-1 Aza-Higashi, Hakozaki, Date, Fukushima, 960-0502, Japan
| | - Ikkoh Yasuda
- General Internal Medicine and Clinical Infectious Diseases, Kita-Fukushima Medical Center, Fukushima, Japan; General Internal Medicine and Clinical Infectious Diseases, Fukushima Medical University, Fukushima, Japan
| | - Shungo Katoh
- General Internal Medicine and Clinical Infectious Diseases, Kita-Fukushima Medical Center, Fukushima, Japan; General Internal Medicine and Clinical Infectious Diseases, Fukushima Medical University, Fukushima, Japan
| | - Eiichiro Sando
- General Internal Medicine and Clinical Infectious Diseases, Kita-Fukushima Medical Center, Fukushima, Japan; General Internal Medicine and Clinical Infectious Diseases, Fukushima Medical University, Fukushima, Japan
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7
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Garnier A, Bourgeois AL, Guillaume T, Peterlin P, Jullien M, Coste‐Burel M, Béné MC, Chevallier P. Efficacy of anti-severe acute respiratory syndrome coronavirus 2 mRNA vaccines in adults with severe acquired aplastic anemia with or without allogeneic hematopoietic stem cell transplantation. EJHAEM 2022; 3:1442-1444. [PMID: 36733664 PMCID: PMC9885527 DOI: 10.1002/jha2.570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 08/26/2022] [Accepted: 08/30/2022] [Indexed: 02/05/2023]
Affiliation(s)
- Alice Garnier
- Department of Clinical HematologyCHU de NantesNantesFrance
| | | | - Thierry Guillaume
- Department of Clinical HematologyCHU de NantesNantesFrance,CNRS, INSERM, CRCI2NAUniversité de NantesNantesFrance
| | | | - Maxime Jullien
- Department of Clinical HematologyCHU de NantesNantesFrance
| | | | - Marie C Béné
- Hematology BiologyCHU de NantesNantesFrance,CNRS, INSERM, CRCI2NAUniversité de NantesNantesFrance
| | - Patrice Chevallier
- Department of Clinical HematologyCHU de NantesNantesFrance,CNRS, INSERM, CRCI2NAUniversité de NantesNantesFrance
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8
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Rajput RV, Ma X, Boswell KL, Gaudinski M, Gordon I, Novik L, Groarke EM, Lotter J, Superata J, Rios OJ, Darden I, Lin BC, Jean-Baptiste N, Carroll R, Moore C, Trost J, Naisan M, Willis J, Serebryannyy L, Wang JL, Prabhakaran M, Narpala SR, Koup RA, McDermott A, Wu CO, Young NS, Patel BA. Clinical outcomes and immune responses to SARS-CoV-2 vaccination in severe aplastic anaemia. Br J Haematol 2022; 199:679-687. [PMID: 36128909 PMCID: PMC9538485 DOI: 10.1111/bjh.18456] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/26/2022] [Accepted: 08/30/2022] [Indexed: 11/27/2022]
Abstract
Patients with severe aplastic anaemia (SAA) are often not vaccinated against viruses due to concerns of ineffective protective antibody response and potential for pathogenic global immune system activation, leading to relapse. We evaluated the impact of COVID‐19 vaccination on haematological indices and disease status and characterized the humoural and cellular responses to vaccination in 50 SAA patients, who were previously treated with immunosuppressive therapy (IST). There was no significant difference in haemoglobin (p = 0.52), platelet count (p = 0.67), absolute lymphocyte (p = 0.42) and neutrophil (p = 0.98) counts prior to and after completion of vaccination series. Relapse after vaccination, defined as a progressive decline in counts requiring treatment, occurred in three patients (6%). Humoural response was detectable in 90% (28/31) of cases by reduction in an in‐vitro Angiotensin II Converting Enzyme (ACE2) binding and neutralization assay, even in patients receiving ciclosporin (10/11, 90.1%). Comparison of spike‐specific T‐cell responses in 27 SAA patients and 10 control subjects revealed qualitatively similar CD4+ Th1‐dominant responses to vaccination. There was no difference in CD4+ (p = 0.77) or CD8+ (p = 0.74) T‐cell responses between patients on or off ciclosporin therapy at the time of vaccination. Our data highlight appropriate humoural and cellular responses in SAA previously treated with IST and true relapse after vaccination is rare.
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Affiliation(s)
- Roma V Rajput
- Hematology Branch, National Heart, Lung, and Blood Institutes, National Institutes of Health, Bethesda, Maryland, USA
| | - Xiaoyang Ma
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Kristin L Boswell
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Martin Gaudinski
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Ingelise Gordon
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Laura Novik
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Emma M Groarke
- Hematology Branch, National Heart, Lung, and Blood Institutes, National Institutes of Health, Bethesda, Maryland, USA
| | - Jennifer Lotter
- Hematology Branch, National Heart, Lung, and Blood Institutes, National Institutes of Health, Bethesda, Maryland, USA
| | - Jeanine Superata
- Hematology Branch, National Heart, Lung, and Blood Institutes, National Institutes of Health, Bethesda, Maryland, USA
| | - Olga J Rios
- Hematology Branch, National Heart, Lung, and Blood Institutes, National Institutes of Health, Bethesda, Maryland, USA
| | - Ivana Darden
- Hematology Branch, National Heart, Lung, and Blood Institutes, National Institutes of Health, Bethesda, Maryland, USA
| | - Bob C Lin
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Nazaire Jean-Baptiste
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Robin Carroll
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Christopher Moore
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Jessica Trost
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Mursal Naisan
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Jacquelyn Willis
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Leonid Serebryannyy
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Jennifer L Wang
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Madhu Prabhakaran
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Sandeep R Narpala
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Richard A Koup
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Adrian McDermott
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Colin O Wu
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Neal S Young
- Hematology Branch, National Heart, Lung, and Blood Institutes, National Institutes of Health, Bethesda, Maryland, USA
| | - Bhavisha A Patel
- Hematology Branch, National Heart, Lung, and Blood Institutes, National Institutes of Health, Bethesda, Maryland, USA
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