Reactions 1871, p265 - 4 Sep 2021
mRNA-1273/ravulizumab S
Breakthrough haemolysis: case report
A 45-year-old woman developed breakthrough haemolysis following an administration of mRNA-1273 vaccine and while receiving ravulizumab for paroxysmal nocturnal haemoglobinuria (PNH).
The woman, who had a history of PNH presented to an emergency room on April 2021 one day following an administration of second dose of mRNA-1273 vaccine [Moderna mRNA SARS-CoV-2 vaccine; dose and route not stated]. She was diagnosed with a classic haemolytic PNH in 1996 and was on unspecified C5 complement inhibitor from 2016. Since 2019, she was receiving subcutaneous ravulizumab weekly [dose and duration of treatment to reaction onset to stated]. She received first dose of the mRNA-1273 vaccine on 24 March 2021. She had no side effects following the first dose. During the presentation, she reported hyperpyrexia (38.8°C) and multiple episodes of vomiting, dark urine and abdominal pain. Blood test revealed severe anaemia with significant intravascular haemolysis (LDH 2.3 ULN), consistent with breakthrough haemolysis. She also had mild thrombocytopenia (100×109/L), moderate neutropenia (0.83×109/L), slightly elevated C reactive protein (3.6 mg/dL), prolonged prothrombin time ratio (1.46) and increased D dimer (895 g/L). Her blood and urine cultures were negative for infection.
The woman started receiving unspecified IV antibiotics, hydration and paracetamol. Her symptoms were gradually improved. She was admitted in a hospital. The breakthrough haemolysis was persisted. She started receiving unspecified low molecular weight heparin. On day 4 from the presentation, her haemoglobin was decreased to 6.7 g/dL with suboptimal reticulocyte counts. She received epoetin-alfa [recombinant human erythropoietin]. Consequently, she had haematological improvement. During the admission, the ravulizumab was continued.
Fattizzo B, et al. SARS-CoV-2 vaccination induces breakthrough hemolysis in paroxysmal nocturnal hemoglobinuria on complement inhibitor. American Journal of Hematology 96: E344-E346, No. 9, 01 Sep 2021. Available from: URL: http://doi.org/10.1002/ajh.26262 803593071
1
Reactions 4 Sep 2021 No. 1871 0114-9954/21/1871-0001/$14.95 Adis © 2021 Springer Nature Switzerland AG. All rights reserved
