Acquired hemophilia A after vaccination against SARS-CoV-2 with the mRNA-1273 (Moderna) vaccine

Melmed, Ava; Kovoor, Andrew; Flippo, Korie

doi:10.1080/08998280.2022.2071121

Cited by 5 publications

(5 citation statements)

References 11 publications

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“…21 In the literature, there have been several cases of AHA occurring after COVID-19 vaccination. [10][11][12][13][14] There is not enough evidence about the causality of COVID-19 vaccines on the occurrence of particular auto-immune phenomena thus causing autoimmune diseases, so this remains unclear and debated. 22 The strength of this study is that, to the best of our knowledge, it reports the first occurrence of AHA after an inactivated COVID-19 vaccination (Sinovac-CoronaVac).…”

Section: Discussionmentioning

confidence: 99%

“…9 Several cases of AHA following COVID-19 vaccines have been described in the literature. [9][10][11][12][13][14] Described as early as in the 18th century, 15 Hemophilia A is a rare bleeding disorder caused by a partial or total deficiency of coagulation factor VIII (FVIII). The concept of a lack of a plasma clotting factor dates back to 1840 16 and since then many extremely effective treatments have been developed.…”

Section: Introductionmentioning

confidence: 99%

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Case Report: Acquired hemophilia A following COVID-19 vaccine

Bouslama,

Ben Ismail,

Zahra

et al. 2024

F1000Res

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Background: In December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified and has subsequently been responsible for immense morbidity and mortality. This resulted in the development of vaccines in record time, potentially posing safety issues. Several cases of acquired hemophilia A (AHA) following coronavirus disease 2019 (COVID-19) vaccines have been described in the literature. AHA is a rare autoimmune disease due to the production of IgG autoantibodies to coagulation FVIII that burdens high morbidity and mortality. It is presumed mainly on identifying an increased activated partial thromboplastin time (aPTT), even without bleeding and is confirmed by determining a FVIII inhibitor. To the best of our knowledge, this is the first report of AHA after inactivated virus COVID-19 treated with low dose rituximab (RTX). Lower RTX doses may lead to shorter infusion duration, lower risk of adverse events and lower costs. Case presentation: We report a case of AHA occurring in a 69-year-old man 60 days after an inactivated Sinovac-coronavac COVID-19 vaccine. Diagnosis of AHA was based on clinical presentation and confirmed with prolonged activated partial thromboplastin time, Factor VIII deficiency and the presence of an FVIII inhibitor. Follow-up showed a significant clinical and biological improvement, aPTT was normalized as of 18 days of treatment with corticosteroids along with low dose rituximab. Conclusions: In the literature, the reported cases of AHA following COVID-19 vaccination occurred after Adenoviral Vector DNA- and SARS-CoV-2 mRNA-based COVID-19 vaccines. Here, AHA was presented following inactivated virus COVID-19 vaccine. AHA treated with low dose rituximab can limit occurrence of side effects and the cost of treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Case Report: Acquired hemophilia A following COVID-19 vaccine

Bouslama,

Ben Ismail,

Zahra

et al. 2024

F1000Res

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“…This promptitude along with the emergency use authorization accorded to many vaccine led people to question vaccination safety and policy [ 12 ]. In the literature, there have been many cases of AHA occurring after COVID-19 vaccination [ 4 , 7 ]. Evidence about the causality of COVID-19 vaccines in the occurrence of a particular auto-immune phenomena thus causing autoimmune still remains unclear and debated [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…This resulted in an unprecedented race by pharmaceutical companies attempting to develop effective vaccines. Shortly after initiation of COVID-19 vaccination, a number of serious vaccine-related diseases such as myocarditis [2], vaccine-induced immune thrombotic thrombocytopenia [3], and acquired hemophilia A (AHA) [4][5][6][7] were reported. As opposed to congenital hemophilia, AHA is a rare autoimmune disease due to the production of IgG autoantibodies to coagulation FVIII that burdens high morbidity and mortality [8].…”

Section: Introductionmentioning

confidence: 99%

Acquired hemophilia A following COVID-19 vaccine: a case report

et al. 2023

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Background In the literature, reported cases of Acquired hemophilia A (AHA) induced by COVID-19 vaccination occurred after Adenoviral Vector Deoxyribonucleic Acid (DNA)- and SARS-CoV-2 Messenger Ribonucleic acid (mRNA)-Based vaccines. Here, and to the best of our knowledge, we report the first case of AHA occurring after an inactivated Sinovac-coronavac COVID-19 vaccine. Case presentation A 69-year-old Tunisian male patient consulted for severe left leg pain limiting physical mobility due to a 5*6 cm large ecchymosis located at the left inner thigh, having spontaneously appeared 5 days prior consultation and without notion of trauma. The patient had no known personal medical history. He had received the second dose of CoronaVac-SinoVac vaccine 30 days prior to consultation. Further physical examination revealed the presence of two other ecchymoses: one at the inner face of the right forearm, starting at the wrist reaching the elbow and the other at the left flank of the abdomen. Diagnosis of AHA was based on clinical presentation and confirmed with prolonged a PTT, Factor VIII deficiency and the presence of an FVIII inhibitor. The patient was successfully treated with corticosteroids and low dose Rituximab. Conclusion Clinicians should consider AHA in front of prolonged aPTT with or without spontaneous bleedings even after inactivated virus COVID-19.

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“…A specific mention deserves attention, being recently identified acquired hemophilia A following coronavirus disease 2019 (COVID-19) vaccination. Although a causality link between vaccine and acquired hemophilia A has not been definitely ascertained, several of such cases have already been reported [ 29 , 30 , 31 , 32 , 33 ]. A possible explanation is that vaccines may foster or boost immune reactions, followed by insurgence of new autoimmune events or exacerbation of pre-existing but latent immune dysregulations, which can ultimately drive the clonal selection of B cells producing specific autoantibodies, including those against FVIII.…”

Section: Autoimmune Disorders Leading To Bleedingmentioning

confidence: 99%

Autoimmune Diseases Affecting Hemostasis: A Narrative Review

Favaloro

Pasalic

Lippi

2022

IJMS

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Hemostasis reflects a homeostatic mechanism that aims to balance out pro-coagulant and anti-coagulant forces to maintain blood flow within the circulation. Simplistically, a relative excess of procoagulant forces can lead to thrombosis, and a relative excess of anticoagulant forces can lead to bleeding. There are a wide variety of congenital disorders associated with bleeding or thrombosis. In addition, there exist a vast array of autoimmune diseases that can also lead to either bleeding or thrombosis. For example, autoantibodies generated against clotting factors can lead to bleeding, of which acquired hemophilia A is the most common. As another example, autoimmune-mediated antibodies against phospholipids can generate a prothrombotic milieu in a condition known as antiphospholipid (antibody) syndrome (APS). Moreover, there exist various autoimmunity promoting environments that can lead to a variety of antibodies that affect hemostasis. Coronavirus disease 2019 (COVID-19) represents perhaps the contemporary example of such a state, with potential development of a kaleidoscope of such antibodies that primarily drive thrombosis, but may also lead to bleeding on rarer occasions. We provide here a narrative review to discuss the interaction between various autoimmune diseases and hemostasis.

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Acquired hemophilia A after vaccination against SARS-CoV-2 with the mRNA-1273 (Moderna) vaccine

Cited by 5 publications

References 11 publications

Case Report: Acquired hemophilia A following COVID-19 vaccine

Case Report: Acquired hemophilia A following COVID-19 vaccine

Acquired hemophilia A following COVID-19 vaccine: a case report

Autoimmune Diseases Affecting Hemostasis: A Narrative Review

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