PO0013 - Sudden onset of spontaneous extensive skin bruising, based on acquired haemophilia A, associated with a COVID-19 infection

Background: COVID-19 infection may be associated with coagulopathy, both thrombotic as well as haemorrhagic events. Bleeding manifestations are rather rare. Our case describes a possible association between acquired haemophilia A (AHA) and COVID-19 infection. This causality has been described only in several cases.

Aims: A 78-year-old male was admitted to hospital for ecchymoses, appearing just over past several days, located on the right breast and the left upper limb, with no history of recent injury. No previous personal or family history of any bleeding symptoms. Concurrently COVID-19 infection was confirmed. During the hospital stay, the skin bruises have further spontaneously extended, covering both the pectoral areas, the abdomen and all extremities.

Methods: Basic laboratory sampling was performed. The isolated presence of striking prolongation of aPTT was discovered (aPTT ratio 4.28, normal range 0.8-1.2). Investigations on prolonged aPTT have been initiated.

Results: Extremely low activity of factor VIII (0.4 %) was found. Further studies have subsequently identified a specific factor VIII inhibitor (24 Bethesda units). During the investigations of the condition no malignancy, autoimmune disorders or drug interactions were disclosed. A 30 % COVID pneumonia was discovered by CT imagining.

Conclusion(s): The diagnosis of AHA was made, most likely due to an acute onset COVID-19 infection. This association can only be speculated for the time being, however, COVID–19 infection induced autoantibody production and influence on coagulation system is described by a number of studies.
We therefore recommend a frequent coagulation monitoring including aPTT in patients admitted with acute COVID‐19 infection and the specific/non-specific inhibitor search in cases with otherwise unexplained onset or worsening of haemorrhagic episodes and/or an aPTT prolongation.