An Acquired Factor VIII Inhibitor in a Patient with HIV and HCV: A Case Presentation and Literature Review

Coagulation factor inhibitors in COVID‐19: From SARS‐CoV‐2 vaccination to infection

Background

Recent reports have highlighted patients with COVID-19 and vaccine recipients diagnosed with coagulation factor inhibitors. This is challenging. as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been identified as a prothrombotic risk factor, with heparin treatment decreasing mortality. However, both infection and vaccination have been associated with immune-mediated hematologic abnormalities, including thrombocytopenia, further rendering these groups at risk for both hemorrhagic and thrombotic events.

Objectives

We sought to characterize the incidence and clinical findings of coagulation factor inhibitors in patients with COVID-19 and vaccine recipients.

Methods

We queried the US Centers for Disease Control and Prevention's Vaccine Adverse Event Reporting System (VAERS), a publicly accessible database, for reports of potential bleeding episodes or coagulation disturbances associated with SARS-CoV-2 vaccination. We performed an additional comprehensive literature review to identify reports of SARS-CoV-2 infection or vaccination-associated coagulation factor inhibitors.

Results

VAERS data showed 58 cases of coagulation factor inhibitors, suggesting a rate of 1.2 cases per 10 million doses. A total of 775 articles were screened and 15 were suitable for inclusion, with six reports of inhibitors after vaccination and nine reports of inhibitors after infection. Inhibitor specificity for factor VIII was most common. Among reported cases, two patients expired due to hemorrhage, one following infection and one following vaccination.

Conclusion

The incidence of coagulation factor inhibitors in patients with SARS-CoV-2 vaccination and infection appears similar to the general population. Nonetheless, given the importance of heparin therapy in treating hospital patients, recognition of inhibitors is important.

Exploring the Complex Role of Coagulation Factor VIII in Chronic Liver Disease

Chronic liver disease is one of the leading causes of death in the United States. Coagulopathy is often a sequela of chronic liver disease, however, the role and regulation of coagulation components in chronic liver injury remain poorly understood. Clinical and experimental evidence indicate that misexpression of the procoagulant factor VIII (FVIII) is associated with chronic liver disease. Nevertheless, the molecular mechanism of FVIII-induced chronic liver injury progression remains unknown. This review provides evidence supporting a pathologic role for FVIII in the development of chronic liver disease using both experimental and clinical models.

Study of Basic Coagulation Parameters among HIV Patients in Correlation to CD4 Counts and ART Status

INTRODUCTION

HIV infection is known to cause coagulation abnormalities by various mechanism, especially during its late course.

AIM

The objective of this study was to analyse platelet count, prothrombin time and activated partial thromboplastin time among HIV infected patients and to analyse these parameters with respect to their CD4 count and ART status.

MATERIALS AND METHODS

A case control study was conducted with 120 HIV infected patients and 40 normal individuals. The blood samples were collected after obtaining consent from the subjects. The blood samples were processed for platelet count, prothrombin time and activated partial thromboplastin time and CD4 count. The results were tabulated and analysed with statistical package.

RESULTS

The platelet count was significantly decreased in HIV infected patients compared to controls. Though HIV patients with CD4 count less than 200cells/mm(3) showed a decreased platelet count compared to those with CD4 count greater than 200cells/mm(3), it was not statistically significant. Prothrombin Time (PT) and Activated Partial Thromboplastin Time (aPTT) was significantly prolonged in HIV patients, but only aPTT showed significant inverse correlation with CD4 count. None of the parameters showed statistical significance on comparing HIV patients on ART with those not on ART.

CONCLUSION

Basic coagulation tests like platelet count, PT and especially aPTT can be used as prospective screening test to assess severity in HIV patients in resource limited settings where CD4 count is not available.

Haematological manifestations of human immune deficiency virus infection

Early in the human immunodeficiency virus (HIV) epidemic, infected patients presented to medical attention with striking abnormalities in each of the major blood cell lineages. The reasons for these derangements remain complex and multifactorial. HIV infects multipotent haematopoietic progenitor cells and establish latent cellular reservoirs, disturbs the bone marrow microenvironment and also causes immune dysregulation. These events lead to cytokine imbalances and disruption of other factors required for normal haematopoiesis. Activation of the reticulo-endothelial system can also result in increased blood cell destruction. The deleterious effects of medications, including first and second generation anti-retroviral agents, on haematopoiesis were well documented in the early years of HIV care; in the current era of HIV-care, the advent of newer and less toxic anti-retroviral drugs have had a more beneficial impact on haematopoiesis. Due to impaired regulation of the immune system and potential side effects of one or more anti-retroviral agents, there is also an increase in coagulation abnormalities such as thromboembolism, and less frequently, acquired disorders of coagulation including thrombotic thrombocytopenic purpura, immune thrombocytopenic purpura and acquired inhibitors of coagulation. In this article we review the epidemiology and aetiology of select non-oncological haematological disorders commonly seen in people living with HIV-acquired immune deficiency syndrome.