Department of Internal Medicine, China Medical University Hospital, China Medical University Hospital, Taichung City, Taiwan.
Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, Taichung City, Taiwan.
Medicine (Baltimore). 2024 May 24;103(21):e38300. doi: 10.1097/MD.0000000000038300.
Acquired hemophilia-A (AHA) is a rare but potentially life-threatening impaired coagulation disorder characterized by the development of autoantibodies against clotting factor VIII. Only a few case reports have been experienced with influenza vaccine-triggered AHA. Here, we report a case of severe hemorrhagic disorder due to AHA following influenza vaccine, which was successfully treated.
The patient presented to the emergency department because of several severe, progressively worsening bruises after receiving the influenza vaccination. Consequently, the patient required intubation due to nasal-oral bleeding, which compromised the airway, and retroperitoneal hemorrhage with shock also developed.
AHA was confirmed through a coagulation factor assay, including coagulation activity and antibody testing, which is possibly triggered by influenza vaccination.
Low-dose cyclophosphamide and hydrocortisone were prescribed until activated partial thromboplastin time showed normal levels. Coagulation factor VIIa was administered, and aggressive blood transfusion was carried out concurrently to address the blood loss.
The upper airway bleeding subsided and bleeding tendencies had been corrected to normal. The patient was smoothly weaned from the ventilator and recovered from critical illness. She was then discharged on the 19th day.
The activated partial thromboplastin time mixing test can be performed immediately to establish the initial differential diagnosis and treatment plan for severe coagulopathy. AHA may be triggered by vaccination, with the hypothesis of activation of autoantibodies and molecular mimicry; this mechanism should be further studied.
获得性血友病 A（AHA）是一种罕见但潜在危及生命的凝血障碍，其特征是针对凝血因子 VIII 产生自身抗体。仅有少数病例报告了流感疫苗引发的 AHA。在此，我们报告了一例流感疫苗接种后因 AHA 引起的严重出血性疾病病例，该病例得到了成功治疗。
患者因接种流感疫苗后出现多处严重、逐渐加重的瘀斑而到急诊就诊。随后，患者因鼻-口腔出血导致气道阻塞而需要插管，同时还发生了腹膜后出血伴休克。
通过凝血因子检测，包括凝血活性和抗体检测，确诊为 AHA，可能由流感疫苗引发。
给予低剂量环磷酰胺和氢化可的松治疗，直至激活部分凝血活酶时间恢复正常。给予凝血因子 VIIa，并同时进行积极输血以控制出血。
上呼吸道出血停止，出血倾向恢复正常。患者顺利脱离呼吸机并从危重病中康复。她在第 19 天出院。
可以立即进行激活部分凝血活酶时间混合试验，以建立严重凝血障碍的初始鉴别诊断和治疗方案。AHA 可能由疫苗接种引发，其机制可能与自身抗体的激活和分子模拟有关，这一机制需要进一步研究。
