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Case Reports
. 2022 May:118:138-140.
doi: 10.1016/j.ijid.2022.02.042. Epub 2022 Feb 24.

Trajectory of SARS-CoV-2 anti-S IgG levels following transfusion and a third dose of BNT162b2 vaccine in a patient with massive postoperative bleeding: A case report

Marino Hirata  1 , Takahiko Fukuchi  2 , Hitoshi Sugawara  2
Affiliations
Case Reports

Trajectory of SARS-CoV-2 anti-S IgG levels following transfusion and a third dose of BNT162b2 vaccine in a patient with massive postoperative bleeding: A case report

Marino Hirata et al. Int J Infect Dis. 2022 May.

Abstract

Objective: Vaccination against SARS-CoV-2 has been shown to be effective in preventing infection and severe disease. Massive bleeding and transfusion after vaccination can lead to a decrease in the antibody level. The effect of an additional dose of vaccine after blood transfusion has not been described previously. In this case report, we report the SARS-CoV-2 anti-S IgG trajectory in a male patient who received a third dose of vaccine after a massive postoperative bleed and blood and plasma transfusion.

Case presentation: A 57-year-old male physician had a SARS-CoV-2 anti-S IgG level of 44 AU/mL, measured using the Lumipulse Presto chemiluminescence assay 3 months after receiving 2 doses of the BNT162b2 vaccine. The patient underwent a hemicolectomy for colon cancer, experienced massive postoperative bleeding, and required a transfusion. The patient's SARS-CoV-2 anti-S IgG level dropped to 9.2 AU/mL. A third dose of BNT162b2 vaccination was administered to reduce the risk of breakthrough infection. Fifteen days after receiving the third vaccine dose, the patient's SARS-CoV-2 anti-S IgG level increased to 421 AU/mL, likely to reflect protection.

Conclusion: This report suggests that administering an extra dose of vaccine is useful for restoring protective antibody levels in vaccinated patients who experience massive postoperative bleeding.

Keywords: BNT162b2 vaccine; COVID-19; Massive bleeding; Plasma transfusion; SARS-CoV-2 anti-S IgG.

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Figures

Figure 1
Figure 1
Trajectory of SARS-CoV-2 anti-S IgG levels in the case patient. SARS-CoV-2 anti-S IgG levels were measured using the Lumipulse Presto chemiluminescence assay. The patient underwent surgery 2 days after admission and received 9 units of red blood cells and 10 units of fresh frozen plasma for massive postoperative bleeding 3 days after admission. The SARS-CoV-2 anti-S IgG levels decreased from 44 AU/mL before admission to 9.2 AU/mL after the transfusion. The patient received the third dose of BNT162b2 vaccine 28 days after admission, and the levels of SARS-CoV-2 anti-S IgG increased to 421 AU/mL 15 days later. anti-S = anti-spike; AU = arbitrary unit; IgG = immunoglobin G; SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2.
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