Acquired hemophilia A secondary to SARS-CoV-2 pneumonia: a case report

New-onset hematologic disorders following COVID-19 vaccination: a systematic review

Purpose

Coronavirus disease 2019 (COVID-19) vaccination reduced morbimortality rates due to severe acute respiratory syndrome coronavirus 2 infection worldwide. However, various complications have been reported, including hematologic disorders.

Materials and Methods

We conducted a systematic review to synthesize and analyze the current available evidence on the development of hematological disorders associated with COVID-19 vaccination.

Results

A total of 227 patients were reported in the papers that were selected to be included. There was a slight predominance of females (n=114, 50.22%) compared to males (n=113, 49.78%), and the calculated mean age was 54.86±18.94 years. The most frequently reported hematological disorders were Immune thrombocytopenic purpura (n=58, 25.55%), followed by thrombotic thrombocytopenic purpura (n=38, 16.74%). The less frequently recorded cases were acquired factor XIII/13 deficiency (n=2, 0.88%) and pernicious anemia (n=2, 0.88%). Messenger RNA (mRNA)-based COVID-19 vaccines, including Pfizer BioNTech 162b2 (n=106, 46.70%), Moderna mRNA 127-3 (n = 42, 18.50%), and the Bivalent vaccine (n = 1, 0.44%), were the most prevalent (n=150, 66.08%). Most cases developed after the first dose (n=120, 52.86%). In most cases, patient outcomes were favorable (n=175, 77.09%), but there were significant mortality cases (n=23, 10.13%).

Conclusion

Our findings suggest close monitoring of patients who receive the first dose with mRNA technology vaccines, regardless of sex, especially in adults, as they appear more vulnerable to developing hematologic disorders.

Trial Registration

PROSPERO Identifier: CRD42023452589.

Hematological Complications in a COVID-19 Patient: A Case Report

Hemophilia A is a hemorrhagic disorder caused by insufficient or inadequate coagulation factor VIII activity. Two different forms are described: congenital, hereditary X-linked, and acquired. Acquired hemophilia A (AHA) is a rare condition and it is defined by the production of autoantibodies neutralizing factor VIII, known as inhibitors. We report the case of a 72-year-old man with a clinical diagnosis of AHA after SARS-CoV-2 infection, which has been described in association with several hematological complications. SARS-CoV-2 infection could represent the immunological trigger for the development of autoantibodies. In our patient, SARS-CoV-2 infection preceded the hemorrhagic complications by 15 days. This lag time is in line with the other cases reported and compatible with the development of an intense immune response with autoantibody production. It is possible that since our patient was affected by type 1 diabetes mellitus, he was more prone to an immune system pathological response against self-antigens. A prompt, appropriate therapeutic intervention with activated recombinant factor VII administration and cyclophosphamide has led to rapid remission of clinical and laboratory findings.