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Chronic cold agglutinin disease after a third COVID-19 mRNA vaccination
Yutaro Suzuki1,2, Teruo Shiba3
1Department of Hematology, Tokyo General Hospital, 3-15-2 Ekota, Nakano-Ku, Tokyo, 165-8906, Japan. yutarosuzuki.jpn4193@gmail.com.
Abstract:
COVID-19 mRNA vaccines manufactured by Pfizer-BioNTech and Moderna have been approved in many countries, and have been administered since 2020. Recent reports of mRNA vaccination exacerbating autoimmune hematologic disorders, such as immune thrombocytopenia or autoimmune hemolytic anemia, have caught the attention of the general public, resulting in alarm over the risks of serious consequences. Meanwhile, in very rare cases, vaccination was reported to trigger new onset of hemolytic anemia. However, it remains unknown whether this was a transient reaction or a persistent event, because all cases reported to date were immediately treated with corticosteroids or rituximab. Here, we present a case of newly diagnosed cold agglutinin disease after a third COVID-19 mRNA vaccination. The patient was followed for 4 months without treatment and continued to exhibit high levels of cold agglutinin and aggregation of red blood cells. The present case indicates that the disease can become chronic, and provides insights into the pathogenesis and treatment strategies.
Insights
COVID-19 mRNA vaccines may rarely trigger cold agglutinin disease, a form of autoimmune hemolytic anemia. This case study shows the condition can persist long-term without treatment, offering insights into its chronic nature.
Area of Science:
- Hematology
- Immunology
- Vaccinology
Background:
- COVID-19 mRNA vaccines (Pfizer-BioNTech, Moderna) are widely used.
- Rare reports suggest mRNA vaccines may exacerbate or trigger autoimmune hematologic disorders.
- The long-term course of vaccine-induced hemolytic anemia remains unclear.
Observation:
- A patient developed cold agglutinin disease (CAD) after a third COVID-19 mRNA vaccine dose.
- The patient was monitored for 4 months without immunosuppressive therapy.
- Persistent high cold agglutinin levels and red blood cell aggregation were observed.
Findings:
- This case demonstrates that COVID-19 mRNA vaccination can lead to persistent cold agglutinin disease.
- The autoimmune hematologic disorder did not resolve spontaneously within the observation period.
- The findings suggest a potential chronic course for vaccine-associated CAD.
Implications:
- Vaccine-induced cold agglutinin disease may be a chronic condition, contrary to assumptions of transient reactions.
- Understanding the chronicity is crucial for managing patients and informing vaccination guidelines.
- Further research into pathogenesis and treatment strategies for vaccine-associated CAD is warranted.
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