Four cases of acquired hemophilia A following immunization with mRNA BNT162b2 SARS-CoV-2 vaccine

Abstract

Acquired hemophilia A (AHA) is a rare autoimmune disease caused by neutralizing autoantibodies against coagulation Factor VIII. Immunomodulatory effects of SARS-CoV-2 vaccination are still poorly understood, with reports of immune-mediated conditions developing after immunization. In the province of Reggio Emilia, Northern Italy, we observed four cases of AHA following SARS-CoV-2 immunization with mRNA BNT162b2 vaccine (produced by Pfizer-BioNTech) during the first eight months from the beginning of SARS-CoV-2 vaccination campaign. During this time frame, 235,597 people received at least one dose of BNT162b2 vaccine. The total population of Reggio Emilia province is 526,349. The unusual observation of four cases of AHA in our province could be of interest and could sensitize healthcare personnel toward a possible complication of SARS-Cov-2 immunization. Nonetheless, vaccination benefits exceed potential side effects and play a central role in individual and public health to effectively protect people from COVID-19 and to stop the pandemic.

Acute-type acquired hemophilia A after COVID-19 mRNA vaccine administration: A new disease entity?

“…Cases of AHA involving young patients that are unrelated to pregnancy are extremely rare. According to the PubMed database, 18 cases of AHA that developed after the administration of an mRNA COVID-19 vaccine had been reported by the end of June 2022 ( Table 1 ) [ 6 , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] ]. As with idiopathic cases, the majority of cases of AHA that arose after the administration of such vaccines involved elderly patients.…”

“… Lemoine C et al [ 15 ] 86 M 14 days after 2nd dose Pfizer BioNTech After 2nd dose Hematoma, anemia Severe 2.1 mPSL After 7 months, the inhibitor became undetectable. Leone MC et al [ 16 ] 73 F 14 days after 1st dose Pfizer BioNTech After 2nd dose Hematomas in knee and jaw Mild 0.8 mPSL After 5 months, the inhibitor became undetectable. Leone MC et al [ 16 ] 67 M 49 days after 2nd dose Pfizer BioNTech After 2nd dose Hematoma of the tongue Mild 2.5 PSL, CPA Six days after discharge, the inhibitor became undetectable.…”

Acquired hemophilia A secondary to SARS-CoV-2 pneumonia

“…Some authors consider that antibodies targeting spike protein are responsible for the development of autoimmunity after SARS-CoV-2 infection because similar immunological re-actions occur after vaccination against SARS-CoV-2, and cross-reactivity has been demonstrated in vitro with a number of human tissue antigens (5,16,17). Ten cases of AHA after SARS-CoV-2 vaccination have been published so far (16)(17)(18)(19)(20)(21)(22)(23)(24).…”

Acquired hemophilia A following SARS CoV-2 mRNA vaccine: Correspondence

“…This clinical issue has been reported in infrequent cases. 2–4 In the case report by Murali et al, 1 the patient had hemorrhagic problem but the cause is still not conclusive. Murali et al 1 described a case and offered etiology theories.…”