Abstract
Background
Evans' syndrome is an uncommon condition defined by the combination (either simultaneously
or sequentially) of immune thrombocytopenia purpura and autoimmune hemolytic anemia
with a positive direct antiglobulin test in the absence of known underlying etiology.
Objectives
We present a case of Evans' syndrome following influenza vaccination.
Case Report
A 50-year-old man with no prior medical history developed Evans' syndrome 4 days after
receiving influenza immunization. The patient improved following treatment with oral
prednisone and intravenous immunoglobulin.
Conclusion
Influenza vaccine is one of the most commonly used vaccines worldwide, with millions
of people being vaccinated annually. Despite its wide use, only sparse information
has been published concerning any hematological effects of this vaccine. The rarity
of such effects supports the safety of using this vaccine.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Acquired hemolytic anemia; the relation of erythrocyte antibody production to activity of the disease; the significance of thrombocytopenia and leukopenia.Blood. 1949; 4: 1196-1213
- Primary thrombocytopenic purpura and acquired hemolytic anemia; evidence for a common etiology.AMA Arch Intern Med. 1951; 87: 48-65
- The spectrum of Evans syndrome in adults: new insight into the disease based on the analysis of 68 cases.Blood. 2009; 114: 3167-3172
- Immunoregulatory abnormalities in Evans syndrome.Am J Hematol. 1983; 15: 381-390
- Mechanisms for the induction of autoimmunity by infectious agents.J Clin Invest. 2001; 108: 1097-1104
- Epidemiology of autoimmune reactions induced by vaccination.J Autoimmun. 2001; 16: 309-318
- Transfusion support with RBCs from an Mk homozygote in a case of autoimmune hemolytic anemia following diphtheria-pertussis-tetanus vaccination.Transfusion. 2002; 42: 567-571
- Management of Evans syndrome.Br J Haematol. 2006; 132: 125-137
- Vaccination-associated immune hemolytic anemia in two children.Transfusion. 2000; 40: 907-909
- Postvaccination thrombocytopenia in Canada.Pediatr Infect Dis J. 2010; 29: 559-561
- Thrombocytopenic purpura after measles-mumps-rubella vaccination: a systematic review of the literature and guidance for management.J Pediatr. 2010; 156: 623-628
- Vaccination associated thrombocytopenic purpura in children.Vaccine. 2007; 25: 1838-1840
- A case of immune thrombocytopenic purpura after influenza vaccination: consequence or coincidence?.J Pediatr Hematol Oncol. 2010; 32: e227-e229
- Hospitalized patients with novel influenza A (H1N1) virus infection - California, April–May, 2009.MMWR Morb Mortal Wkly Rep. 2009; 58: 536-541
- Hospitalized patients with 2009 H1N1 influenza in the United States, April–June 2009.N Engl J Med. 2009; 361: 1935-1944
- Clinical features and rapid viral diagnosis of human disease associated with avian influenza A H5N1 virus.Lancet. 1998; 351: 467-471
- Investigation of avian influenza (H5N1) outbreak in humans–Thailand, 2004.MMWR Morb Mortal Wkly Rep. 2006; 55: S3-S6
- Immune thrombocytopenic purpura following influenza vaccination.Isr Med Assoc J. 2006; 8: 322-323
- Vaccination-Associated relapse of immune thrombocytopenia.JAMA. 1981; 245: 369-370
- [Severe autoimmune thrombopenia following anti-influenza vaccination].Presse Med. 2003; 32 (Article in French): 1223-1224
- [Acute idiopathic thrombocytopenic purpura after anti-influenza vaccination].Medicina (Firenze). 1989; 9 (Article in Italian): 417-418
- Idiopathic thrombocytopenic purpura after influenza vaccination in a bone marrow transplantation recipient.Bone Marrow Transplant. 2006; 38 (author reply 4–5): 323-324
- Thrombocytopenic purpura after the administration of an influenza vaccine in a patient with autoimmune liver disease.Digestion. 2008; 77: 159-160
- Refractory thrombotic thrombocytopenic purpura following influenza vaccination.Anaesthesia. 2009; 64: 444-446
- Autoimmune hemolytic anemia following MF59-adjuvanted influenza vaccine administration: a report of two cases.Ann Pharmacother. 2011; 45: e8
- Could autoimmunity be induced by vaccination?.Int Rev Immunol. 2010; 29: 247-269
Article info
Publication history
Published online: July 16, 2012
Accepted:
January 18,
2012
Received in revised form:
July 14,
2011
Received:
February 7,
2011
Footnotes
Reprints are not available.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
