New-onset aplastic anemia after SARS-CoV-2 vaccination

Int J Hematol. 2023 Dec;118(6):667-681. doi: 10.1007/s12185-023-03666-z. Epub 2023 Sep 28.


Aplastic anemia (AA) is a rare autoimmune disease. Drugs, viruses, and radiation are among the most common etiologic factors, and most cases have immune pathophysiology. SARS-CoV-2 vaccines have been linked with rare side effects, including cases of acquired aplastic anemia. Here we review all the reported cases of new-onset AA after SARS-CoV-2 vaccination, and discuss their clinical characteristics and management. 18 patients in these case reports had a median age of 58 years. The time from vaccination to onset of aplastic anemia ranged from 1 day to 7 months, with a median of 2.5 weeks. Seventeen patients were diagnosed with severe or very severe aplastic anemia post-vaccination and all patients received standard treatments for acquired aplastic anemia. Seventeen patients achieved a complete or partial response and only 1 patient died. Aplastic anemia can be considered a very rare SARS-CoV-2 vaccine-related adverse event, although a causative relationship has not been proven. Reporting cases of such uncommon post-vaccination events could help clinicians to consider aplastic anemia when pancytopenia is observed after vaccination. The benefits of SARS-Cov-2 vaccination are established, and reports of rare events serve only to increase awareness in daily clinical practice.

Keywords: Adverse events; Aplastic anemia; Case reports; SARS-CoV-2; Vaccine.

Publication types

  • Review

MeSH terms

  • Anemia, Aplastic* / etiology
  • Anemia, Aplastic* / therapy
  • COVID-19 Vaccines / adverse effects
  • COVID-19* / prevention & control
  • Humans
  • Middle Aged
  • Rare Diseases
  • SARS-CoV-2
  • Vaccination / adverse effects


  • COVID-19 Vaccines