Rare Risk of Acquired Hemophilia A Seen Following COVID-19 Infection, Vaccination

Researchers of a new letter are highlighting the rare potential of acquired hemophilia A (AHA) following COVID-19 and COVID-19 vaccination.

The group, publishing their findings in Thrombosis Research, detailed a case of AHA following infection and again following vaccination, and they provided additional insights through their systematic review of available data.

“Recently AHA has been diagnosed in patients with COVID-19 or after anti–COVID-19 vaccination,” explained the researchers. “These findings are quite interesting although not surprising, considering the already known immune dysregulation following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the association between AHA and vaccinations, especially against influenza and tuberculosis. Possible pathophysiological mechanisms of vaccine-triggered autoimmunity lie in the activation of quiescent autoreactive T and B cells, as well as molecular mimicry.”

Through systematic review of published data between September 2020 and 2022, the researchers identified 29 cases of AHA associated with COVID-19 infection or vaccination, the majority (72.4%) of which detailed cases of ADA associated with mRNA vaccination. In these cases, nearly half of the 21 patients experienced the onset of AHA following the second dose.

In their case report, the group detailed the case of a 67-year-old man experiencing an episode of AHA following COVID-19 infection in 2020 and again a year later after receiving his first vaccination against COVID-19. The man had also experienced an idiopathic episode 10 years prior.

After presenting to the emergency department with spontaneous cutaneous and muscle bleeding at the torso and limbs following vaccination, testing again determined hemophilia A, which was coupled with a differentiated liposarcoma diagnosis.

“Although we cannot rule out an association between AHA onset and cancer diagnosis, the case reported here is exceptional because it describes for the first time a possible double relapse of AHA following COVID-19 first and then after vaccination against SARS-CoV-2,” commented the researchers.

The patient’s onset of symptoms occurred 3 weeks following his first dose of an mRNA vaccine against COVID-19. Following the AHA diagnosis, his bleeding was successfully treated with recombinant factor VIIa, and inhibitor eradication with rituximab was started. Complete remission was achieved 5 weeks after the last dose of rituximab.

Data from the systematic review showed that onset AHA occurred a median of 14 (range, 4-90) days following vaccination and a median of 7 (range, 1-120) days following infection. Consistent with data from international registries, complete remission was achieved in 60.7% of cases, with a mortality rate of 10.3%.

Reference

Franchini M, Focosi D. Association between SARS-CoV-2 infection or vaccination and acquired hemophilia A: a case report and literature update. Thromb Res. Published online December 17, 2022. doi:10.1016/j.thromres.2022.12.010