Severe aplastic anemia after COVID-19 mRNA vaccination: Causality or coincidence?

J Autoimmun. 2022 Jan:126:102782. doi: 10.1016/j.jaut.2021.102782. Epub 2021 Dec 14.


The development of various autoimmune diseases has been reported after COVID-19 infections or vaccinations. However, no method for assessing the relationships between vaccines and the development of autoimmune diseases has been established. Aplastic anemia (AA) is an immune-mediated bone marrow failure syndrome. We report a case of severe AA that arose after the administration of a COVID-19 vaccine (the Pfizer-BioNTech mRNA vaccine), which was treated with allogeneic hematopoietic stem cell transplantation (HSCT). In this patient, antibodies against the SARS-CoV-2 spike protein were detected both before and after the HSCT. After the patient's hematopoietic stem cells were replaced through HSCT, his AA improved despite the presence of anti-SARS-CoV-2 antibodies. In this case, antibodies derived from the COVID-19 vaccine may not have been directly involved in the development of AA. This case suggests that the measurement of vaccine antibody titers before and after allogeneic HSCT may provide clues to the pathogenesis of vaccine-related autoimmune diseases. Although causality was not proven in this case, further evaluations are warranted to assess the associations between vaccines and AA.

Keywords: Aplastic anemia; Bone marrow transplantation; COVID-19; SARS-CoV-2; Vaccination.

Publication types

  • Case Reports

MeSH terms

  • Anemia, Aplastic / chemically induced*
  • Antibodies, Viral / blood
  • BNT162 Vaccine / adverse effects*
  • COVID-19 / prevention & control*
  • Hematopoietic Stem Cell Transplantation*
  • Humans
  • Male
  • Middle Aged
  • Spike Glycoprotein, Coronavirus / immunology


  • Antibodies, Viral
  • Spike Glycoprotein, Coronavirus
  • spike protein, SARS-CoV-2
  • BNT162 Vaccine