Case of acquired haemophilia a in Southeast Asia following COVID-19 vaccine

Abstract

Acquired haemophilia A (AHA) is a rare bleeding disorder with high morbidity and mortality, but it is eminently treatable if diagnosis and treatment are prompt. We report a case of AHA in Southeast Asia following the administration of the Pfizer-BioNTech COVID-19 vaccine. A man in his 80s developed multiple bruises 2 weeks after his first dose of the COVID-19 vaccine. Diagnosis was delayed due to his cognitive impairment and low clinical suspicion. This led to a representation with worsening ecchymosis, a left thigh haematoma and symptomatic anaemia. Laboratory testing was notable for an isolated prolongation of the activated partial thromboplastin time, which remained uncorrected in the mixing test. Further testing confirmed the presence of factor VIII (FVIII) inhibitors and low FVIII titres of 6.7%. He responded to treatment with intravenous methylprednisolone and recombinant activated FVII. Screening for autoimmune diseases and malignancies was negative.

Acquired hemophilia following COVID‐19 vaccination: Case report and review of literature

“…No specific test is available to establish causality. Until now, only a few cases of AHA following any type of COVID‐19 vaccinations have been reported, 5 , 6 , 12 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 despite billions of administered doses of COVID‐19 vaccines and a high level of public and health care alertness to possible vaccine‐related adverse events. During an extensive worldwide vaccination campaign, it is likely that the onset of a rare disease will temporarily coincide with vaccination.…”

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.…”

“… Soliman DS et al [ 18 ] 80 M 2 weeks after 1st dose Pfizer BioNTech After 1st dose Hematoma of the thigh, anemia Severe 7.5 mPSL, PSL, AZ After 6 weeks, the inhibitor became undetectable. Ai Vuen L et al [ 19 ] 75 M 3 months after 2nd dose Pfizer BioNTech After 2nd dose Ecchymoses, anemia Severe 318 PSL, Rit, CPA, CyA Improved Al Hennawi H et al [ 20 ] 77 M 3 weeks after 2nd dose Moderna mRNA-1273 After 2nd dose Ecchymoses Mild 71.6 PSL, CPA After 5 weeks, the inhibitor level had decreased to 49 BU/mL. Fu PA et al [ 21 ] 72 M 9 days after 3rd dose Moderna mRNA-1273 After 3rd dose Ecchymoses, anemia Severe 158.6 PSL, CPA, Rit After 3 weeks, the inhibitor level had decreased to 20.6 BU/mL.…”

Acquired hemophilia A secondary to SARS-CoV-2 pneumonia

“…Some authors consider that antibodies targeting spike protein are responsible for the development of autoimmunity after SARS-CoV-2 infection because similar immunological re-actions occur after vaccination against SARS-CoV-2, and cross-reactivity has been demonstrated in vitro with a number of human tissue antigens (5,16,17). Ten cases of AHA after SARS-CoV-2 vaccination have been published so far (16)(17)(18)(19)(20)(21)(22)(23)(24).…”