PB0047 - Covid-19 vaccination & Acquired Hemophilia A: the case of a middle aged woman

Sunday, July 10, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Presenting Author(s)

Melanie Daniel, MD

MD
Hematology Transfusion, Lille Hospital University, 59000, Lille, France
Lille, Nord-Pas-de-Calais, France

Co-Author(s)

CP

Camille Paris

MD
Lille University Hospital
Lille, Nord-Pas-de-Calais, France
AH

Audrey Hochart

MD
Lille University Hospital
Lille, Nord-Pas-de-Calais, France
NT

Nathalie Trillot

MD
Lille University, CHU, Department of Haematology and Clinical Haemostasis Unit, Lille, France
Lille, Nord-Pas-de-Calais, France
AR

Antoine Rauch, MD, PhD

University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, France
Lille, Nord-Pas-de-Calais, France
BW

Benedicte Wibaut

MD
Lille University Hospital
Lille, Nord-Pas-de-Calais, France
EJ

Emmanuelle Jeanpierre

PharmD
Lille University Hospital, Lille, France
Lille, Nord-Pas-de-Calais, France
MD

Maximilien DESVAGES

PharmD
Lille University Hospital, Hematology Transfusion, 59000, Lille, France
LILLE, Nord-Pas-de-Calais, France
CZ

Christophe Zawadzki, PharmD PhD

PharmD, PhD
Lille University, CHU, Department of Haematology, Lille, France
Lille, Nord-Pas-de-Calais, France
AB

Anne Bauters

PharmD
Hematologie Biologique, CHU Lille, France
Lille, Nord-Pas-de-Calais, France
FL

Fanny Lassalle

PharmD
Lille University Hospital
Lille, Nord-Pas-de-Calais, France
AT

Antoine Tournoys

PharmD
Lille University Hospital
Lille, Nord-Pas-de-Calais, France
AD

Annabelle Dupont

Professor, PharmD, PhD
University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, France
Lille, Nord-Pas-de-Calais, France
LT

Louis Terriou

MD
Lille University Hospital
Lille, Nord-Pas-de-Calais, France
Sophie Susen, MD, PhD

Professor, MD, PhD
CRC-MHC, Lille University Hospital, Lille, France
Lille, Nord-Pas-de-Calais, France

Background: Acquired hemophilia A (AHA) is a rare bleeding condition defined by the development of autoantibodies directed against clotting factor VIII (FVIII). It occurs primarily in elderly patients. AHA is associated with comorbidities such as cancer, autoimmune disease and infections. There is growing literature on AHA during or following SARS-CoV-2 infection or vaccination. Six previous cases of AHA post Covid-19 vaccination have been described; all patients were older than 65 years old (yo).

Aims: We report on a 45 yo woman presenting with AHA after COVID-19 vaccination. She had no personal or family history of bleeding disorders. Eighteen days after her 2nd dose of Pfizer-BioNTech COVID-19 vaccine, she presented with recurring hematomas.
Bleeding events were both spontaneous and provoked by minor traumas but with a disproportionate size. The aim of this report is to bring to light the association between AHA and COVID-19 vaccine in a younger patient with no ongoing or recent pregnancy.

Methods: Case report

Results: Biological explorations showed a prolonged activated partial thromboplastin time (aPTT) at 75 seconds (ratio 2.42). FVIII was undetectable and von Willebrand factor explorations were normal. Anti-FVIII antibodies were positive at 373 Bethesda units (BU/mL) confirming the diagnosis of AHA. There was no evidence of pregnancy, cancer, auto-immune disorder or infectious disease.
Immunosuppression was initiated with prednisone (1mg/kg), then intensified with rituximab.
Bleeding was controlled with repeated infusions of activated prothrombin complex concentrate (aPCC, Feiba®) at a dose of 60 IU/kg/injection.
A 3rd dose of Covid-19 mRNA vaccine was contraindicated.

Conclusion(s): To our knowledge this is the first case of AHA post Covid-19 vaccination in a patient under 50 yo. The exact mechanisms responsible for autoimmune disorders following vaccination are still unclear. However this report might suggest that AHA diagnosis in this context may not be a simple statistical coincidence. Physicians should remain wary of this possible complication.