Acquired Autoimmune Hemophilia Following SARS-CoV-2 Vaccines: Dual-Drug Effects on Blood Coagulation and the Scylla and Charybdis Phenomenon

Acquired hemophilia A following COVID-19 vaccine: a case report

BACKGROUND

In the literature, reported cases of Acquired hemophilia A (AHA) induced by COVID-19 vaccination occurred after Adenoviral Vector Deoxyribonucleic Acid (DNA)- and SARS-CoV-2 Messenger Ribonucleic acid (mRNA)-Based vaccines. Here, and to the best of our knowledge, we report the first case of AHA occurring after an inactivated Sinovac-coronavac COVID-19 vaccine.

CASE PRESENTATION

A 69-year-old Tunisian male patient consulted for severe left leg pain limiting physical mobility due to a 5*6 cm large ecchymosis located at the left inner thigh, having spontaneously appeared 5 days prior consultation and without notion of trauma. The patient had no known personal medical history. He had received the second dose of CoronaVac-SinoVac vaccine 30 days prior to consultation. Further physical examination revealed the presence of two other ecchymoses: one at the inner face of the right forearm, starting at the wrist reaching the elbow and the other at the left flank of the abdomen. Diagnosis of AHA was based on clinical presentation and confirmed with prolonged a PTT, Factor VIII deficiency and the presence of an FVIII inhibitor. The patient was successfully treated with corticosteroids and low dose Rituximab.

CONCLUSION

Clinicians should consider AHA in front of prolonged aPTT with or without spontaneous bleedings even after inactivated virus COVID-19.

Short-time Safety of the Sinopharm COVID-19 Vaccine in Patients with Hemophilia

Background: The COVID-19 pandemic, caused by SARS-Cov-2, has affected the care of patients with hemophilia, indicating the necessity of their vaccination. Nevertheless, there are concerns about using anti-SARS-Cov-2 virus vaccines for hemophilic patients, particularly concerning bleeding adverse events. Methods: Following a cross-sectional design, all adult hemophilic patients who received two doses of Sinopharm anti-SARS-Cov-2 virus vaccine in Afzalipour Hospital, Kerman, Iran, during May and June 2021 were recruited. The participants were followed for two weeks after receiving each dose of vaccine. Results: Fifty-one patients with a mean age of 37.07 ± 11.45 years were included, of whom 27 (61.4 %) patients experienced at least one adverse reaction. Pain was the most frequent local adverse event (occurred in 20 (39.2%) and 15 (29.4%) cases after 1st and 2nd doses, respectively). Menometrorrhagia and epistaxis were reported by two and one patients, respectively. Conclusions: Overall Sinopharm anti-SARS-Cov-2 virus vaccine seems to be safe for patients with hemophilia in the short term.