Case of Acquired Haemophilia a in Southeast Asia Following COVID-19 Vaccine

Overview

Journal BMJ Case Rep

Specialty General Medicine

Date 2022 Mar 10

PMID 35264381

Authors

Lee Ai Vuen

Evelyn Aun Su-Yin

Ahlam Naila Kori

T M Shah

Affiliations

Soon will be listed here.

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.

Citing Articles

Acquired Hemophilia A after SARS-CoV-2 Immunization: A Narrative Review of a Rare Side Effect.

Castelli R, Gidaro A, Manetti R, Castiglia P, Delitala A, Mannucci P Vaccines (Basel). 2024; 12(7).

PMID: 39066347 PMC: 11281676. DOI: 10.3390/vaccines12070709.

Blood Coagulation and Thrombotic Disorders following SARS-CoV-2 Infection and COVID-19 Vaccination.

Sekulovski M, Mileva N, Vasilev G, Miteva D, Gulinac M, Peshevska-Sekulovska M Biomedicines. 2023; 11(10).

PMID: 37893186 PMC: 10604891. DOI: 10.3390/biomedicines11102813.

Acquired hemophilia A (AHA) due to anti-SARS-CoV-2 vaccination: A systematic review.

Amisha F, Saluja P, Malik P, van Rhee F EJHaem. 2023; 4(2):532-543.

PMID: 37206259 PMC: 10188482. DOI: 10.1002/jha2.604.

Pharmacovigilance signals from active surveillance of mRNA platform vaccines (tozinameran and elasomeran).

Valnet-Rabier M, Tebacher M, Gautier S, Micallef J, Salvo F, Pariente A Therapie. 2023; 78(5):499-507.

PMID: 37012149 PMC: 10007713. DOI: 10.1016/j.therap.2023.03.005.

Acquired Hemophilia A: An Update on the Etiopathogenesis, Diagnosis, and Treatment.

Zanon E Diagnostics (Basel). 2023; 13(3).

PMID: 36766524 PMC: 9914651. DOI: 10.3390/diagnostics13030420.

References

Radwi M, Farsi S . A case report of acquired hemophilia following COVID-19 vaccine. J Thromb Haemost. 2021; 19(6):1515-1518. PMC: 8250362. DOI: 10.1111/jth.15291. View

Hafzah H, McGuire C, Hamad A . A Case of Acquired Hemophilia A Following SARS-CoV-2 Infection. Cureus. 2021; 13(7):e16579. PMC: 8380307. DOI: 10.7759/cureus.16579. View

Franchini M, Glingani C, De Donno G, Casari S, Caruso B, Terenziani I . The first case of acquired hemophilia A associated with SARS-CoV-2 infection. Am J Hematol. 2020; 95(8):E197-E198. PMC: 7273016. DOI: 10.1002/ajh.25865. View

Cittone M, Battegay R, Condoluci A, di Bergamo L, Fernandes E, Galfetti E . The statistical risk of diagnosing coincidental acquired hemophilia A following anti-SARS-CoV-2 vaccination. J Thromb Haemost. 2021; 19(9):2360-2362. PMC: 9771119. DOI: 10.1111/jth.15421. View

Pirrotta M, Bernardeschi P, Fiorentini G . A case of acquired haemophilia following H1N1 vaccination. Haemophilia. 2011; 17(5):815. DOI: 10.1111/j.1365-2516.2011.02493.x. View

Ellis G, Whitehead M, Robinson D, ONeill D, Langhorne P . Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials. BMJ. 2011; 343:d6553. PMC: 3203013. DOI: 10.1136/bmj.d6553. View

Lemoine C, Giacobbe A, Bonifacino E, Karapetyan L, Seaman C . A case of acquired haemophilia A in a 70-year-old post COVID-19 vaccine. Haemophilia. 2021; 28(1):e15-e17. PMC: 8652744. DOI: 10.1111/hae.14442. View

Thomas S, Moreira Jr E, Kitchin N, Absalon J, Gurtman A, Lockhart S . Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine through 6 Months. N Engl J Med. 2021; 385(19):1761-1773. PMC: 8461570. DOI: 10.1056/NEJMoa2110345. View

Cines D, Bussel J . SARS-CoV-2 Vaccine-Induced Immune Thrombotic Thrombocytopenia. N Engl J Med. 2021; 384(23):2254-2256. PMC: 8063912. DOI: 10.1056/NEJMe2106315. View

10.

Baden L, El Sahly H, Essink B, Kotloff K, Frey S, Novak R . Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine. N Engl J Med. 2020; 384(5):403-416. PMC: 7787219. DOI: 10.1056/NEJMoa2035389. View

11.

Moulis G, Pugnet G, Bagheri H, Courtellemont C, Huart A, Chauveau D . Acquired factor VIII haemophilia following influenza vaccination. Eur J Clin Pharmacol. 2010; 66(10):1069-70. DOI: 10.1007/s00228-010-0852-z. View

12.

Tiede A, Klamroth R, Scharf R, Trappe R, Holstein K, Huth-Kuhne A . Prognostic factors for remission of and survival in acquired hemophilia A (AHA): results from the GTH-AH 01/2010 study. Blood. 2014; 125(7):1091-7. PMC: 4326770. DOI: 10.1182/blood-2014-07-587089. View

13.

Bernabei R, Venturiero V, Tarsitani P, Gambassi G . The comprehensive geriatric assessment: when, where, how. Crit Rev Oncol Hematol. 2000; 33(1):45-56. DOI: 10.1016/s1040-8428(99)00048-7. View

14.

Palmer K, Onder G . Comprehensive geriatric assessment: Benefits and limitations. Eur J Intern Med. 2018; 54:e8-e9. DOI: 10.1016/j.ejim.2018.02.016. View

15.

Bitting R, Bent S, Li Y, Kohlwes J . The prognosis and treatment of acquired hemophilia: a systematic review and meta-analysis. Blood Coagul Fibrinolysis. 2009; 20(7):517-23. DOI: 10.1097/MBC.0b013e32832ca388. View

16.

Souayah N, Nasar A, Suri M, Qureshi A . Guillain-Barré syndrome after vaccination in United States: data from the Centers for Disease Control and Prevention/Food and Drug Administration Vaccine Adverse Event Reporting System (1990-2005). J Clin Neuromuscul Dis. 2009; 11(1):1-6. DOI: 10.1097/CND.0b013e3181aaa968. View

17.

Knoebl P, Marco P, Baudo F, Collins P, Huth-Kuhne A, Nemes L . Demographic and clinical data in acquired hemophilia A: results from the European Acquired Haemophilia Registry (EACH2). J Thromb Haemost. 2012; 10(4):622-31. DOI: 10.1111/j.1538-7836.2012.04654.x. View

18.

Wang K, Shah P, Roarke D, Shakil S . Severe acquired haemophilia associated with asymptomatic SARS-CoV-2 infection. BMJ Case Rep. 2021; 14(7). PMC: 8292732. DOI: 10.1136/bcr-2021-242884. View

19.

Delgado J, Jimenez-Yuste V, Hernandez-Navarro F, Villar A . Acquired haemophilia: review and meta-analysis focused on therapy and prognostic factors. Br J Haematol. 2003; 121(1):21-35. DOI: 10.1046/j.1365-2141.2003.04162.x. View

20.

Tiede A, Collins P, Knoebl P, Teitel J, Kessler C, Shima M . International recommendations on the diagnosis and treatment of acquired hemophilia A. Haematologica. 2020; 105(7):1791-1801. PMC: 7327664. DOI: 10.3324/haematol.2019.230771. View