疫苗相關的再障在歐美也有報道，亞洲再障發病率比歐美高2-3倍， 國人人口基數又大，如果隻有這幾個報道的話， 國內疫苗相關的再障發生率不能算高。但這些病人非常不幸，衷心希望今後有方法可以事先預測。
這是英國人的報告
http://www.patient.co.uk/doctor/aplastic-anaemia
。。。。。。
There have been anecdotal reports of vaccination producing bone marrow failure or triggering relapse of aplastic anaemia, so vaccinations, including influenza vaccinations, should only be given when absolutely necessary.[1]
1. Guidelines for the diagnosis and management of aplastic anaemia; British Committee for Standards in Haematology (April 2009)
這是美國人的
http://onlinelibrary.wiley.com/doi/10.1002/ajh.20153/pdf
You have free access to this content
American Journal of HematologyVolume 77, Issue 2, Article first published online: 23 SEP 2004
Case Reports of Aplastic Anemia After Vaccine
Administration
To the Editor:
Acquired aplastic anemia is a rare disorder resulting from
damage to the hematopoietic stem cells by chemicals, drugs, viruses, or
unknown antigens [1]. Several observations support an immune-mediated
mechanism. We report two healthy young male patients who presented with
aplastic anemia shortly after receiving immunizations with hepatitis B vaccine
(boost) 7 days prior to presentation and anthrax vaccine 30 days prior to
presentation. We propose that vaccine administration may have provided the
immunologic stimuli resulting in aplasia.
CASE 1
A 25-year-old healthy male presented to the ER with diffuse skin lesions and
bruises of his extremities of 24-hr duration. His initial labs showed WBC
count of 2200/mL, Hgb 14.6 g/dL, Hct 40%, and platelet count 4000/mL. He
received a booster dose of hepatitis B vaccine 7 days prior to admission. The
only positive physical findings were petechiae of oral mucosa and petechiae of
the upper and lower extremities with occasional ecchymoses. Liver function
test showed SGPT 747, SGOT 222, bilirubin 0.8, and alkaline phosphatase
49. Follow-up laboratory tests showed decreasing liver function tests over a
2-week period. Initially he received prednisone and IVIG for ITP, but there
was no improvement in his counts so on the 4th hospital day, a bone marrow
biopsy was performed, which showed hypocellular marrow with 15% cellu-
larity. The number of megakaryocytes was markedly decreased. Diagnosis was consistent with aplastic anemia.
After a month, a repeat bone marrow biopsy was performed which again
showed 5% cellularity. He ultimately received an allogeneic bone marrow
transplant.
CASE 2
A 19-year-old male military recruit was admitted with progressive petechiae
of his extremities and torso. He received anthrax vaccine approximately
1 month prior to his admission. CBC showed WBC 4600/
mL, Hgb 9.1 g/dL,Hct 25.7%, and platelet count of 2000/mL. He was initially treated with
prednisone and IVIG. His platelet count did not improve, so a bone marrow
biopsy was performed which showed 40% cellularity and markedly decreased
megakaryocytes. These findings were consistent with aplastic anemia. He
ultimately received an allogeneic bone marrow transplant.
In both of these patients, further work-up showed negative HIV tests.
Serologic study for parvovirus, CMV IgM, and ANA was negative. Hepa-
titis A ab and hepatitis C Ab (HCVPCR), Hepatitis B core Ab, and
hepatitis B surface Ag tests were negative. Hepatitis B surface Ab titers
were high (>150) in the patient who received a prior hepatitis B vaccine.
Case reports of pancytopenia, lupus-like disease, and exacerbation of
certain autoimmune diseases such as multiple sclerosis have been described
after hepatitis B vaccination, but aplastic anemia has not been reported [2–4].
A causal relationship between the vaccination and aplastic anemia could be
supported by close temporal relationship between these events and clinical
and laboratory findings. We hypothesize that an underlying immune predis-
position might have enabled the vaccine to trigger the vigorous cytotoxic T
lymphocyte response that possibly led to aplastic anemia.
Benefits of vaccine administration still outweigh the risks. More studies
are needed to establish the causal relationship between vaccine administra-
tion and aplastic anemia.
CHIRAG SHAH
S
HEILA
L
EMKE
V
INITA
S
INGH
T
ERESA
G
ENTILE
SUNY Upstate Medical University, Syracuse, New York
Published online in Wiley InterScience (www.interscience.wiley.com).
DOI: 10.1002/ajh.20153
R
EFERENCES
1. Young NS. Acquired aplastic anemia. Ann Intern Med 2002;136(7):534–546.
2. Viallard JF, Boiron JM, Parrens M, Moreau JF. Severe pancytopenia triggered by
recombinant hepatitis B vaccine. Br J Hematol 2000;110:230–233.
3. Nadler JP. Multiple sclerosis and hepatitis B vaccination. Clin Infect Dis
1993;17:928–929.
4. Ashok Shenoy K, Prabha Adhikari MR, Chakrapani M, Shenoy D, Pillai A.
Pancytopenia after recombinant hepatitis B vaccine—an Indian case report. Br J
Hematol 2001;114(4):955.
————————
這是英國人的報告
http://www.patient.co.uk/doctor/aplastic-anaemia
。。。。。。
There have been anecdotal reports of vaccination producing bone marrow failure or triggering relapse of aplastic anaemia, so vaccinations, including influenza vaccinations, should only be given when absolutely necessary.[1]
1. Guidelines for the diagnosis and management of aplastic anaemia; British Committee for Standards in Haematology (April 2009)
這是美國人的
http://onlinelibrary.wiley.com/doi/10.1002/ajh.20153/pdf
You have free access to this content
American Journal of HematologyVolume 77, Issue 2, Article first published online: 23 SEP 2004
Case Reports of Aplastic Anemia After Vaccine
Administration
To the Editor:
Acquired aplastic anemia is a rare disorder resulting from
damage to the hematopoietic stem cells by chemicals, drugs, viruses, or
unknown antigens [1]. Several observations support an immune-mediated
mechanism. We report two healthy young male patients who presented with
aplastic anemia shortly after receiving immunizations with hepatitis B vaccine
(boost) 7 days prior to presentation and anthrax vaccine 30 days prior to
presentation. We propose that vaccine administration may have provided the
immunologic stimuli resulting in aplasia.
CASE 1
A 25-year-old healthy male presented to the ER with diffuse skin lesions and
bruises of his extremities of 24-hr duration. His initial labs showed WBC
count of 2200/mL, Hgb 14.6 g/dL, Hct 40%, and platelet count 4000/mL. He
received a booster dose of hepatitis B vaccine 7 days prior to admission. The
only positive physical findings were petechiae of oral mucosa and petechiae of
the upper and lower extremities with occasional ecchymoses. Liver function
test showed SGPT 747, SGOT 222, bilirubin 0.8, and alkaline phosphatase
49. Follow-up laboratory tests showed decreasing liver function tests over a
2-week period. Initially he received prednisone and IVIG for ITP, but there
was no improvement in his counts so on the 4th hospital day, a bone marrow
biopsy was performed, which showed hypocellular marrow with 15% cellu-
larity. The number of megakaryocytes was markedly decreased. Diagnosis was consistent with aplastic anemia.
After a month, a repeat bone marrow biopsy was performed which again
showed 5% cellularity. He ultimately received an allogeneic bone marrow
transplant.
CASE 2
A 19-year-old male military recruit was admitted with progressive petechiae
of his extremities and torso. He received anthrax vaccine approximately
1 month prior to his admission. CBC showed WBC 4600/
mL, Hgb 9.1 g/dL,Hct 25.7%, and platelet count of 2000/mL. He was initially treated with
prednisone and IVIG. His platelet count did not improve, so a bone marrow
biopsy was performed which showed 40% cellularity and markedly decreased
megakaryocytes. These findings were consistent with aplastic anemia. He
ultimately received an allogeneic bone marrow transplant.
In both of these patients, further work-up showed negative HIV tests.
Serologic study for parvovirus, CMV IgM, and ANA was negative. Hepa-
titis A ab and hepatitis C Ab (HCVPCR), Hepatitis B core Ab, and
hepatitis B surface Ag tests were negative. Hepatitis B surface Ab titers
were high (>150) in the patient who received a prior hepatitis B vaccine.
Case reports of pancytopenia, lupus-like disease, and exacerbation of
certain autoimmune diseases such as multiple sclerosis have been described
after hepatitis B vaccination, but aplastic anemia has not been reported [2–4].
A causal relationship between the vaccination and aplastic anemia could be
supported by close temporal relationship between these events and clinical
and laboratory findings. We hypothesize that an underlying immune predis-
position might have enabled the vaccine to trigger the vigorous cytotoxic T
lymphocyte response that possibly led to aplastic anemia.
Benefits of vaccine administration still outweigh the risks. More studies
are needed to establish the causal relationship between vaccine administra-
tion and aplastic anemia.
CHIRAG SHAH
S
HEILA
L
EMKE
V
INITA
S
INGH
T
ERESA
G
ENTILE
SUNY Upstate Medical University, Syracuse, New York
Published online in Wiley InterScience (www.interscience.wiley.com).
DOI: 10.1002/ajh.20153
R
EFERENCES
1. Young NS. Acquired aplastic anemia. Ann Intern Med 2002;136(7):534–546.
2. Viallard JF, Boiron JM, Parrens M, Moreau JF. Severe pancytopenia triggered by
recombinant hepatitis B vaccine. Br J Hematol 2000;110:230–233.
3. Nadler JP. Multiple sclerosis and hepatitis B vaccination. Clin Infect Dis
1993;17:928–929.
4. Ashok Shenoy K, Prabha Adhikari MR, Chakrapani M, Shenoy D, Pillai A.
Pancytopenia after recombinant hepatitis B vaccine—an Indian case report. Br J
Hematol 2001;114(4):955.
————————
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