Abstract
A male in his teens with a history of liver transplant for biliary atresia (aged 2 years) and autoimmune haemolytic anaemia (AIHA, aged 6 years) presented with jaundice, dark urine, fatigue and chest discomfort that began 48 hours after the first dose of SARS-CoV-2 Pfizer-BioNTech vaccine (BNT162b2 mRNA). Investigations revealed a warm AIHA picture. Over 4 weeks the patient developed life-threatening anaemia culminating in haemoglobin of 35 g/L (after transfusion), lactate dehydrogenase of 1293 units/L and bilirubin of 228 µmol/L, refractory to standard treatment with corticosteroids and rituximab. An emergency splenectomy was performed that slowed haemolysis but did not completely ameliorate it. Eculizumab, a terminal complement pathway inhibitor, was initiated to arrest intravascular haemolysis and showed a favourable response. AIHA is rare but described after the SARS-CoV-2 Pfizer-BioNTech vaccine. This case highlights the rare complication of AIHA, the use of emergency splenectomy for disease control, and the use of eculizumab.
Keywords: Haematology (incl blood transfusion); Transplantation.
【저자키워드】 transplantation., haematology (incl blood transfusion), 【초록키워드】 Corticosteroid, SARS-CoV-2, Vaccine, fatigue, eculizumab, lactate dehydrogenase, Haemoglobin, Chest, male, Urine, Autoimmune, inhibitor, disease, liver, Pfizer-BioNTech, Blood, BNT162b2 mRNA, investigation, Bilirubin, transplantation, Complement pathway, standard treatment, first dose, life-threatening, warm, jaundice, over, highlight, described, the patient, was performed, initiated, 48 hour, the SARS-CoV-2, 【제목키워드】 Vaccine, complement, Autoimmune, Pfizer-BioNTech, BNT162b2 mRNA, warm, the SARS-CoV-2,