A previously treated severe haemophilia A patient developed high-titre inhibitor after vaccinations

Abstract

<jats:p> The factor VIII (FVIII)-neutralizing antibody (inhibitor) seen in 25%–30% of patients with severe haemophilia A (SHA). Vaccination is a non-genetic risk factor of inhibitor development as ‘danger signal’ which may provide a pro-inflammatory microenvironment to increase FVIII immunogenicity. We reported a previously treated SHA patient postponed the first vaccination to 15-month age received diphtheria-pertussis-tetanus intramuscularly. At 18-month age, the patient received Hepatitis A intramuscularly and Varicella Zoster Virus subcutaneously with 2 weeks interval and FVIII infusion was given &lt;24 h prior for each. Successive bleedings occurred 1 week later with inefficacy of FVIII replacement. High-titre inhibitor was tested at 117 exposure days. This case suggested that continuous vaccinations in close proximity to FVIII could induce inhibitor. The relationship between vaccination and FVIII immunogenicity still needs to be revealed by further study. </jats:p>

Autoimmune- and complement-mediated hematologic condition recrudescence following SARS-CoV-2 vaccination

“…All are associated with autoimmune disorders and malignancies. 13 , 14 ITP and acquired hemophilia A can be triggered by vaccines 10 , 15 , 16 , 17 , 18 and viral infections, including SARS-CoV-2. 19 , 20 The pathogenesis of postviral de novo ITP is thought to involve molecular mimicry and circulating immune complexes.…”

Acquired hemophilia following COVID‐19 vaccination: Case report and review of literature

“… 1 , 2 Mortality is high and most commonly because of fatal bleeding, infection, underlying disease, or complications of the immunosuppressive therapy. There are reports of AHA, following vaccination 3 , 4 , 5 , 6 or COVID‐19 infection. 7 , 8 , 9 , 10 We report a case of AHA, diagnosed shortly after an Vaxzevria ChAdOx1‐S SARS‐CoV‐2 vaccination (AstraZeneca) and reviewed literature to evaluate if there could be an association between COVID‐19 vaccination and (a recurrence of) AHA.…”

“…1,2 Mortality is high and most commonly because of fatal bleeding, infection, underlying disease, or complications of the immunosuppressive therapy. There are reports of AHA, following vaccination [3][4][5][6] or COVID-19 infection. [7][8][9][10] We report…”