Senda Ayami, Saito Hideaki, Kusakabe Shinsuke, Yoshida Koki, Shibata Kumi, Kida Shuhei, Toda Jun, Hino Akihisa, Ueda Tomoaki, Fujita Jiro, Fukushima Kentaro, Yokota Takafumi, Kashiwagi Hirokazu, Hosen Naoki
Department of Hematology and Oncology, Osaka University.
Department of Hematology, Daini Osaka Police Hospital.
Rinsho Ketsueki. 2023;64(1):35-41. doi: 10.11406/rinketsu.64.35.
Acquired hemophilia A (AHA) is a rare disease characteized by bleeding symptoms caused by decreased factor VIII activity due to the appearance of inhibitors to factor VIII triggered by malignancy or collagen disease. An 86-year-old woman developed purpura on her extremities after the first dose of the BNT162b2 mRNA COVID-19 vaccine. This symptom subsided after a few days. After the second dose of the BNT162b2 mRNA COVID-19 vaccine, purpura appeared again, and the patient was referred to our hospital Her APTT was remarkably prolonged to 110 seconds, and a cross-mixing test revealed an inhibitor pattern. Since FVIII activity was <1% and FVIII inhibitor was 51.6 BU, she was diagnosed with AHA. Prednisolone therapy was started, and coagulative complete remission was achieved. Because acquired hemophilia can develop after mRNA COVID-19 vaccination, as in this case, it is critical to monitor the appearance of bleeding symptom.
获得性血友病A（AHA）是一种罕见疾病，其特征是由于恶性肿瘤或胶原病引发针对凝血因子VIII的抑制物，导致凝血因子VIII活性降低，从而出现出血症状。一名86岁女性在接种第一剂BNT162b2 mRNA新冠疫苗后，四肢出现紫癜。几天后该症状消退。在接种第二剂BNT162b2 mRNA新冠疫苗后，紫癜再次出现，患者被转诊至我院。她的活化部分凝血活酶时间（APTT）显著延长至110秒，交叉配血试验显示为抑制物模式。由于凝血因子VIII活性<1%且凝血因子VIII抑制物为51.6 Bethesda单位（BU），她被诊断为获得性血友病A。开始使用泼尼松龙治疗，并实现了凝血完全缓解。正如本例所示，由于接种mRNA新冠疫苗后可能发生获得性血友病，因此监测出血症状的出现至关重要。
