Acquired Hemophilia A After SARS-CoV-2 Infection: A Case Report

Nardella, Jennifer; Comitangelo, Domenico; Marino, Renato; Malcangi, Giuseppe; Barratta, Marco Damiano; Sabbà, Carlo; Perrone, Antonio

doi:10.14740/jmc3921

Cited by 7 publications

(6 citation statements)

References 19 publications

(12 reference statements)

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“…Namely, both onset and relapse of immune thrombocytopenic purpura [10] and immune-mediated thrombotic thrombocytopenic purpura [11] were described in the literature, along with a new condition characterized by thrombocytopenia accompanied by thrombosis and antibodies against platelet factor 4 (PF4) in the serum (defined vaccine-induced thrombotic thrombocytopenic -VITT-) [12] . Finally, like in our patient, cases of AHA onset following vaccination have been described, thus improving our knowledge of the possible underlying pathophysiological mechanisms, although establishing a specific causal relationship between the vaccine and these autoimmune disorders can be challenging due to several variables related to a single case [13] , [14] , [15] , [16] . Despite difficulties in establishing a specific correlation, several working groups, including Leone and colleagues, have reported an increase in the incidence of AHA in the months following the worldwide SARS-CoV-2 immunization period (between 14 and 52 days from vaccination day and AHA-related treatment start) [17] .…”

Section: Discussionmentioning

confidence: 90%

Acquired hemophilia A following COVID-19 vaccination – The importance of prompt diagnosis: A case report

Duminuco¹,

Calagna²,

Markovic³

et al. 2023

Transfusion and Apheresis Science

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Section: Discussionmentioning

confidence: 90%

Acquired hemophilia A following COVID-19 vaccination – The importance of prompt diagnosis: A case report

Duminuco¹,

Calagna²,

Markovic³

et al. 2023

Transfusion and Apheresis Science

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“…In the last few years, cases of AHA in COVID patients have been described, both after infection and vaccination [15][16][17][18][19][20][21][22][23][24][25]. A few cases of AHA following the viral infection have been reported in literature [15,[26][27][28][29][30]. Our first hypothesis is that SARS-CoV-2 infection acted as the immunological trigger for the development of autoantibodies.…”

Section: Discussionmentioning

confidence: 99%

Hematological Complications in a COVID-19 Patient: A Case Report

Ianuà,

Caldarelli,

De Matteis

et al. 2023

Diseases

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Hemophilia A is a hemorrhagic disorder caused by insufficient or inadequate coagulation factor VIII activity. Two different forms are described: congenital, hereditary X-linked, and acquired. Acquired hemophilia A (AHA) is a rare condition and it is defined by the production of autoantibodies neutralizing factor VIII, known as inhibitors. We report the case of a 72-year-old man with a clinical diagnosis of AHA after SARS-CoV-2 infection, which has been described in association with several hematological complications. SARS-CoV-2 infection could represent the immunological trigger for the development of autoantibodies. In our patient, SARS-CoV-2 infection preceded the hemorrhagic complications by 15 days. This lag time is in line with the other cases reported and compatible with the development of an intense immune response with autoantibody production. It is possible that since our patient was affected by type 1 diabetes mellitus, he was more prone to an immune system pathological response against self-antigens. A prompt, appropriate therapeutic intervention with activated recombinant factor VII administration and cyclophosphamide has led to rapid remission of clinical and laboratory findings.

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“…Malignant disease has been ruled out, but the exclusion of autoimmune disease was not reported although she had fibromyalgia in medical history. Nardella et al showed a 53-year-old woman treated under the diagnosis of AHA ( 11 ). They concluded that AHA may have been associated with SARS-CoV-2 infection based on SARS-CoV-2 anti-spike antibodies, although she also had signs and symptoms of autoimmune thyroiditis.…”

Section: Discussionmentioning

confidence: 99%

Acquired hemophilia A secondary to SARS-CoV-2 pneumonia

Brkić

Marija

Marija³

et al. 2022

Biochem. med. (Online)

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The acquired hemophilia A (AHA) is a life-threatening condition. The incidence of AHA is extremely low, which requires a multidisciplinary approach to diagnosis and treatment. This is case report of 73-year-old man who presented with AHA secondary to severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) pneumonia. The patient had extensive skin bleeding and hematomas. In the coagulation screening tests activated partial thromboplastin time (APTT) was prolonged with normal prothrombin time (PT), which was indication for further investigation. The APTT in a mixing study with normal plasma did not correct so clotting factors inhibitors were suspected. With signs of bleeding, extremely low factor VIII (FVIII) activity (2%) and presence of FVIII inhibitors, AHA was diagnosed and treatment initiated. Patient was treated with factor eight inhibitor bypassing agent (FEIBA) for three days, followed by long-term corticosteroid and cyclophosphamide therapy. Malignant and autoimmune diseases as the most common causes of AHA were ruled out. The patient had a good response to therapy with gradual normalization of APTT and FVIII activity. To the best of our knowledge, the present case is the first reported case of de novo AHA after SARS-CoV-2 pneumonia. The diagnosis of AHA should be suspected in a patient with bleeding into the skin and mucous membranes without a previous personal and family history of bleeding, and with isolated prolonged APTT. It is important to investigate any isolated prolongation of APTT in cooperation with clinical laboratory experts.

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Acquired Hemophilia A After SARS-CoV-2 Infection: A Case Report

Cited by 7 publications

References 19 publications

Acquired hemophilia A following COVID-19 vaccination – The importance of prompt diagnosis: A case report

Acquired hemophilia A following COVID-19 vaccination – The importance of prompt diagnosis: A case report

Hematological Complications in a COVID-19 Patient: A Case Report

Acquired hemophilia A secondary to SARS-CoV-2 pneumonia

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