Amisha Fnu, Saluja Prachi, Malik Paras, Van Rhee Frits
Department of Internal Medicine University of Arkansas for Medical Sciences Little Rock Arkansas USA.
Department of Internal Medicine Jacobi Medical Center-Albert Einstein College of Medicine Bronx New York USA.
EJHaem. 2023 Mar 10;4(2):532-543. doi: 10.1002/jha2.604. eCollection 2023 May.
Vaccination against SARS-CoV2 has been the largest vaccination campaign over the past two decades. The aim of this study is to qualitatively assess the reported cases of acquired hemophilia A (AHA) that developed after COVID-19 vaccination to further elaborate on incidence, presentation, treatment, and outcomes.We queried Medline (PubMed), Google Scholar, and Embase databases to find reported cases of AHA after COVID-19 vaccines. We found 14 studies (19 cases) for this descriptive analysis. Most patients were elderly (mean age 73 years) and males ( = 12) with multiple comorbidities. All cases developed after mRNA vaccines - BNT162b2 Pfizer-BioNTech ( = 13) and mRNA-1273 Moderna ( = 6). All except one patient were treated, with the most common therapy being a combination of steroids, immunosuppression, and rFVIII ( = 13). Two patients died due to acute respiratory distress, and gall bladder rupture with persistent bleeding, respectively. While evaluating a patient with bleeding diathesis after COVID-19 vaccination, AHA should be kept in the differential diagnosis. Given the low incidence, we believe that the benefit of vaccination still outweighs the risk of disease acquisition.
针对严重急性呼吸综合征冠状病毒2（SARS-CoV2）的疫苗接种是过去二十年来规模最大的疫苗接种行动。本研究的目的是对新冠病毒疫苗接种后发生的获得性甲型血友病（AHA）报告病例进行定性评估，以进一步阐述其发病率、临床表现、治疗方法及预后情况。我们检索了医学文献数据库（PubMed）、谷歌学术和Embase数据库，以查找新冠病毒疫苗接种后AHA的报告病例。我们找到了14项研究（共19例病例）用于此项描述性分析。大多数患者为老年人（平均年龄73岁），男性（n = 12），且患有多种合并症。所有病例均在接种信使核糖核酸（mRNA）疫苗后发生——辉瑞-BioNTech的BNT162b2（n = 13）和莫德纳的mRNA-1273（n = 6）。除1例患者外，其他所有患者均接受了治疗，最常见的治疗方法是类固醇、免疫抑制和重组人凝血因子VIII联合使用（n = 13）。两名患者分别因急性呼吸窘迫和胆囊破裂伴持续性出血死亡。在评估新冠病毒疫苗接种后出现出血素质的患者时，应将AHA列入鉴别诊断范围。鉴于发病率较低，我们认为接种疫苗的益处仍大于感染疾病的风险。
