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Vaccination-associated immune hemolytic anemia in two children
A Seltsam1, S Shukry-Schulz, A Salama
1Blood Bank and Division of Hematology/Oncology, Department of Internal Medicine, Charité University Hospital/Virchow Clinic, Humboldt University, Berlin, Germany.
Background:
Two children in whom acute autoimmune hemolytic anemia (AIHA) developed after vaccination were studied.
Case Reports:
The children were a 20-month-old girl and a 21-month-old boy. The diagnosis of AIHA was made in accordance with established criteria (hemolysis, positive DAT, and lack of other reasons for the hemolysis). Serologic tests were performed according to standard technique.
Results:
The girl experienced two attacks of hemolysis. The first episode occurred 2 weeks after oral polio vaccination, and the second episode was observed 7 months later, when she received a simultaneous vaccination against mumps, rubella, and measles. The DAT was strongly positive with anti-C3d. No autoantibodies were detectable in either episode. The boy experienced acute hemolysis a few days after a simultaneous revaccination against diphtheria-pertussis-tetanus, Haemophilus influenzae, hepatitis B, and polio. The DAT using anti-IgG was strongly positive, and the DAT performed with anti-C3d was weakly positive.
Conclusion:
Vaccination-induced AIHA resembles those forms of AIHA related to infectious diseases, and it may occur more frequently than has been reported.