Hemolysis induced by SARS-CoV-2 mRNA vaccination in patients with paroxysmal nocturnal hemoglobinuria

Review Hematology

How I treat paroxysmal nocturnal hemoglobinuria

Robert A. Brodsky

Summary: Paroxysmal nocturnal hemoglobinuria (PNH) is a rare complement-mediated hemolytic anemia with diverse manifestations, requiring differentiated treatment approaches; terminal complement inhibition is effective for intravascular hemolysis treatment but not bone marrow failure; novel complement inhibitors under clinical development show promising prospects for future applications.

BLOOD (2021)

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Letter Hematology

COVID-19 vaccines induce severe hemolysis in paroxysmal nocturnal hemoglobinuria

Gloria F. Gerber et al.

BLOOD (2021)

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Review Immunology

Complement Mediated Hemolytic Anemias in the COVID-19 Era: Case Series and Review of the Literature

Bruno Fattizzo et al.

Summary: The complex relationship between SARS-CoV-2 infection and complement activation is actively being investigated, with exacerbations of complement-mediated diseases occurring during COVID-19 infection. Hemolytic episodes in conditions like PNH, AIHA, CAD, and HUS may benefit from complement inhibitors. Severe hemolytic exacerbations during COVID-19 infection may require greater therapeutic intervention compared to those after SARS-CoV-2 vaccination, highlighting the importance of vaccination in this patient population. Treatment choices should be based on the severity of hemolysis and COVID-19 infection, with options including transfusions, complement inhibitors, steroids, rituximab, plasma exchange, hemodialysis, and anti-thrombotic prophylaxis.

FRONTIERS IN IMMUNOLOGY (2021)

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Article Hematology

Autoimmune- and complement-mediated hematologic condition recrudescence following SARS-CoV-2 vaccination

Andrew Jay Portuguese et al.

Summary: This article discusses the recurrence of autoimmune and complement-mediated hematologic conditions after COVID-19 vaccination, presenting three illustrative cases. It describes the exacerbation of immune thrombocytopenia, acquired von Willebrand Disease/acquired hemophilia A, and paroxysmal nocturnal hemoglobinuria following SARS-CoV-2 vaccination. It highlights the need for monitoring and risk assessment in patients with underlying autoimmune and complement-mediated hematologic conditions.

BLOOD ADVANCES (2021)

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Article Hematology

Danicopan: an oral complement factor D inhibitor for paroxysmal nocturnal hemoglobinuria

Antonio M. Risitano et al.

Summary: In this phase II trial, danicopan monotherapy effectively inhibits intravascular hemolysis and increases hemoglobin concentration in untreated PNH patients, without evidence of C3-mediated extravascular hemolysis.

HAEMATOLOGICA (2021)

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Article Hematology