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

Publication date: Jun 25, 2024

Acquired hemophilia A (AHA) is a rare bleeding disorder (1. 4 per million inhabitants per year) caused by neutralizing antibodies against factor VIII. Although uncommon, these autoantibodies can cause a high rate of morbidity and mortality. Several conditions are linked with AHA; based on an EACH2 study, 3. 8% of AHA could be connected to infection. In the last four years, most humans have contracted the SARS-CoV-2 infection or have been vaccinated against it. Whether or not COVID-19 immunization might induce AHA remains controversial. This review aims to evaluate the evidence about this possible association. Overall, 18 manuscripts (2 case series and 16 case reports) were included. The anti-SARS-CoV-2 vaccination, as also happens with other vaccines, may stimulate an autoimmune response. However, older individuals with various comorbidities are both at risk of developing AHA and of COVID-19-related morbidity and mortality. Therefore, the COVID-19 vaccine must always be administered because the benefits still outweigh the risks. Yet, we should consider the rare possibility that the activation of an immunological response through vaccination may result in AHA. Detailed registries and prospective studies would be necessary to analyze this post-vaccine acquired bleeding disorder, looking for possible markers and underlying risk factors for developing the disease in association with vaccination.

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Concepts	Keywords
Basel	acquired hemophilia A
Controversial	BNT162b2
Covid	CoronaVac
Hemophilia	COVID-19
Vaccine	inactivated vaccine
	mRNA vaccines
	mRNA-1273
	SARS-CoV-2
	vaccine
	Vaxzevria
	viral vector vaccine

Semantics

Type	Source	Name
disease	MESH	Hemophilia A
disease	VO	immunization
drug	DRUGBANK	Acetohydroxamic acid
disease	MESH	bleeding
drug	DRUGBANK	Beroctocog alfa
disease	MESH	morbidity
disease	MESH	infection
disease	MESH	SARS-CoV-2 infection
pathway	REACTOME	SARS-CoV-2 Infection
disease	VO	vaccinated
disease	VO	vaccination
disease	MESH	autoimmune response
disease	VO	COVID-19 vaccine
disease	VO	vaccine
disease	MESH	Thrombosis
drug	DRUGBANK	Coenzyme M
disease	VO	inactivated vaccine
disease	VO	CoronaVac
disease	MESH	epistaxis
disease	MESH	hematomas
disease	MESH	hemarthrosis
disease	MESH	cerebral hemorrhage
disease	MESH	autoimmune diseases
disease	MESH	cancers
disease	MESH	pemphigus
disease	MESH	psoriasis
disease	MESH	Multiple myeloma
disease	MESH	lymphomas
disease	MESH	monoclonal gammopathy
disease	MESH	myelofibrosis
disease	MESH	Rheumatic diseases
disease	MESH	Rheumatoid arthritis
pathway	KEGG	Rheumatoid arthritis
disease	MESH	systemic lupus erythematosus
pathway	KEGG	Systemic lupus erythematosus
disease	MESH	Sjogren’s syndrome
disease	MESH	Goodpasture’s syndrome
disease	MESH	temporal arteritis
disease	MESH	myasthenia gravis
disease	MESH	thyroiditis
disease	MESH	multiple sclerosis
disease	MESH	Infectious diseases
disease	MESH	hepatitis B
pathway	KEGG	Hepatitis B
disease	VO	Viruses
disease	IDO	immunodeficiency
disease	MESH	miscarriage
drug	DRUGBANK	Chloramphenicol
drug	DRUGBANK	Clopidogrel
drug	DRUGBANK	Fludarabine
drug	DRUGBANK	Natural alpha interferon
disease	MESH	Asthma
pathway	KEGG	Asthma
disease	MESH	chronic obstructive pulmonary disease
disease	MESH	hepatitis
disease	MESH	pneumonia
disease	VO	organization
disease	MESH	severe acute respiratory syndrome
drug	DRUGBANK	ANX-510
disease	IDO	process
drug	DRUGBANK	Omega-3 fatty acids
drug	DRUGBANK	Von Willebrand Factor Human
disease	MESH	viral infections
disease	VO	organ
disease	IDO	production
disease	MESH	pediatric inflammatory multisystem syndrome
drug	DRUGBANK	L-Lysine
disease	MESH	convulsions
disease	MESH	lymphopenia
disease	MESH	abnormalities
drug	DRUGBANK	Inositol
disease	MESH	inflammation
disease	MESH	syndrome
disease	MESH	lung injury
drug	DRUGBANK	Prothrombin
drug	DRUGBANK	Heparin
disease	IDO	cell
disease	MESH	Miller Fisher syndrome
disease	MESH	immune thrombocytopenia
disease	MESH	myocarditis
disease	MESH	pericarditis
disease	MESH	thrombocytopenia
disease	MESH	adenovirus infection
disease	MESH	complications
disease	MESH	pulmonary embolism
disease	MESH	deep vein thrombosis
disease	IDO	history
disease	MESH	ischemic stroke
disease	MESH	arterial occlusion
drug	DRUGBANK	Trestolone
drug	DRUGBANK	Methionine
disease	VO	dose
disease	MESH	cardiovascular diseases
disease	MESH	chronic diseases
disease	MESH	sarcoma
disease	MESH	bullous pemphigoid
disease	MESH	sepsis
disease	MESH	ecchymosis
disease	MESH	death
disease	MESH	pulmonary sarcoidosis
drug	DRUGBANK	Cyclophosphamide
drug	DRUGBANK	Amoxicillin
drug	DRUGBANK	Clavulanic acid
drug	DRUGBANK	Anakinra
drug	DRUGBANK	Emicizumab
drug	DRUGBANK	Coagulation factor VIIa Recombinant Human
drug	DRUGBANK	Factor IX Complex (Human)
drug	DRUGBANK	Rituximab
disease	VO	publication
disease	MESH	diabetes mellitus
disease	MESH	hypertrophy
disease	IDO	blood
drug	DRUGBANK	Tranexamic acid
drug	DRUGBANK	Anti-inhibitor coagulant complex
drug	DRUGBANK	Desmopressin
disease	VO	age
disease	MESH	noma
disease	MESH	hemothorax
disease	MESH	Peripheral artery disease
disease	MESH	Aortic valve stenosis
drug	DRUGBANK	Resiniferatoxin
disease	MESH	anemia
disease	MESH	Hematuria
disease	MESH	Dementia
disease	MESH	cardiac failure
disease	MESH	chronic kidney disease
disease	MESH	glaucoma
disease	MESH	Hypertension
disease	MESH	carpal tunnel syndrome
disease	MESH	sarcoma 37
disease	MESH	ulcer
disease	MESH	foot ulcer
disease	MESH	Atrial fibrillation
disease	MESH	acute kidney injury
drug	DRUGBANK	Meticillin
disease	MESH	Liposarcoma
disease	VO	population
disease	VO	adverse event
drug	DRUGBANK	Coagulation factor VII human
disease	VO	titer
disease	VO	COVID-19 inactivated vaccine

Original Article

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