Acquired Hemophilia A Post-COVID-19 Vaccination: A Case Report and Review

Abstract

Acquired hemophilia A (AHA) is an inhibitory coagulopathy that represents a rare variant of hemorrhagic syndromes. We present a case of idiopathic AHA in a 75-year-old male patient with a cutaneous hematoma that could be attributed to a recent COVID-19 vaccination. The aim of this report is to raise awareness of a possible association between AHA and COVID-19 vaccination and to review similar reported cases and management plans to prevent the development of possible morbidity and debilitating complications. This case illustrates an exceptionally rare side effect of the COVID-19 vaccination. The advantages of obtaining the COVID-19 vaccine outweigh the risks.

Case Report: Acquired Haemophilia A Following mRNA-1273 Booster Vaccination Against SARS-CoV-2 With Concurrent Diagnosis of Pleomorphic Dermal Sarcoma

“…This case illustrates that a thorough diagnostic work-up for malignancy is mandatory at the diagnosis of AHA, even if other immune-mediated triggers seem equally likely. As previously observed, there is a close temporal association with symptoms starting nine days following vaccination in our case within a similar timeframe of one to three weeks ( 9 , 10 , 14 – 20 ). The patient in this case report was treated with prednisone (100 mg per day) and received CYC (150 mg per day) and RTX (375 mg/m 2 ) in a slightly accelerated version of the current recommendations of the German Society of Thrombosis and Haemostasis Research (GTH).…”

“…If PR is not achieved, the guidelines recommend CYC (week 4-6) followed by RTX (week 7-10) ( 8 ). Our literature research revealed that most published cases of AHA after SARS-CoV-2 vaccination were treated with steroids (9 out of 10), one patient received CYC alone, one patient RTX alone, two patients combined CYC/RTX treatment and one patient azathioprine ( 14 – 20 ). There was one fatality after arterial bleeding from a ruptured gallbladder, all other cases of AHA in association with SARS-CoV-2 vaccination resolved or were resolving at the time of publication ( 14 – 20 ).…”

“…During the ongoing coronavirus pandemic, AHA has also been described as an autoimmune phenomenon associated with SARS-CoV-2 infection ( 11 – 13 ). Most recently, immunization with both mRNA vaccines against SARS-CoV-2 (BNT162b2 by Pfizer/BioNTech as well as mRNA-1273 by Moderna) has been reported as a trigger for AHA in single cases ( 14 – 20 ). However, it remains unclear if SARS-CoV-2 booster vaccination can also trigger AHA.…”

Acute-type acquired hemophilia A after COVID-19 mRNA vaccine administration: A new disease entity?

“…Cases of AHA involving young patients that are unrelated to pregnancy are extremely rare. According to the PubMed database, 18 cases of AHA that developed after the administration of an mRNA COVID-19 vaccine had been reported by the end of June 2022 ( Table 1 ) [ 6 , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] ]. As with idiopathic cases, the majority of cases of AHA that arose after the administration of such vaccines involved elderly patients.…”

Acquired Hemophilia A: A possibly fatal complication of SARS-COV-2 infection

“…Leone et al reported four incidences of AHA in the Italian population after administration of Pfizer-BioNTech mRNA Covid-19 vaccine [ 11 ]. Al Hennawi et al also reported cutaneous hematomas on multiple sites in a 75-year old male after the administration of the second dose of the same vaccine [ 12 ]. A similar case was also reported by Radwi et al, with presentation of hematomas after both doses of Pfizer-BioNTech Covid vaccine in a 69-year old male [ 13 ].…”