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This resulted in the development of vaccines in record time, potentially posing safety issues. Several cases of acquired hemophilia A (AHA) following coronavirus disease 2019 (COVID-19) vaccines have been described in the literature. AHA is a rare autoimmune disease due to the production of IgG autoantibodies to coagulation FVIII that burdens high morbidity and mortality. It is presumed mainly on identifying an increased activated partial thromboplastin time (aPTT), even without bleeding and is confirmed by determining a FVIII inhibitor. To the best of our knowledge, this is the first report of AHA after inactivated virus COVID-19 treated with low dose rituximab (RTX). Lower RTX doses may lead to shorter infusion duration, lower risk of adverse events and lower costs. Case presentation: We report a case of AHA occurring in a 69-year-old man 60 days after an inactivated Sinovac-coronavac COVID-19 vaccine. Diagnosis of AHA was based on clinical presentation and confirmed with prolonged activated partial thromboplastin time, Factor VIII deficiency and the presence of an FVIII inhibitor. Follow-up showed a significant clinical and biological improvement, aPTT was normalized as of 18 days of treatment with corticosteroids along with low dose rituximab. Conclusions: In the literature, the reported cases of AHA following COVID-19 vaccination occurred after Adenoviral Vector DNA- and SARS-CoV-2 mRNA-based COVID-19 vaccines. Here, AHA was presented following inactivated virus COVID-19 vaccine. AHA treated with low dose rituximab can limit occurrence of side effects and the cost of treatment." } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/13-65/v1", "name": "Case Report: Acquired hemophilia A following COVID-19 vaccine" } } ] } Home Browse Case Report: Acquired hemophilia A following COVID-19 vaccine ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Bouslama E, Ben Ismail H, Zahra K et al. Case Report: Acquired hemophilia A following COVID-19 vaccine [version 1; peer review: awaiting peer review] . F1000Research 2024, 13 :65 ( https://doi.org/10.12688/f1000research.128372.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Case Report Case Report: Acquired hemophilia A following COVID-19 vaccine [version 1; peer review: awaiting peer review] Emna Bouslama https://orcid.org/0000-0002-2619-3280 1 , Hajer Ben Ismail 1 , Kmira Zahra https://orcid.org/0000-0002-6695-075X 1 , [...] Nadia Sassi 1 , Yossra Dhaha 2 , Amina Bouatay 2 , Yosra Ben Boussef 1 , Nesrine Ben Sayed 1 , Haifa Regaieg 1 , Abderrahim Khelif 1 Emna Bouslama https://orcid.org/0000-0002-2619-3280 1 , Hajer Ben Ismail 1 , [...] Kmira Zahra https://orcid.org/0000-0002-6695-075X 1 , Nadia Sassi 1 , Yossra Dhaha 2 , Amina Bouatay 2 , Yosra Ben Boussef 1 , Nesrine Ben Sayed 1 , Haifa Regaieg 1 , Abderrahim Khelif 1 PUBLISHED 12 Jan 2024 Author details Author details 1 hematology departement, University Hospital Farhat Hached, Sousse, Sousse, Tunisia 2 Hematology laboratory, Sahloul University Hospital, Sousse, Tunisia Emna Bouslama Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Resources, Supervision, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Hajer Ben Ismail Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Resources, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Kmira Zahra Roles: Conceptualization, Data Curation, Methodology, Supervision, Validation, Writing – Review & Editing Nadia Sassi Roles: Conceptualization, Data Curation, Validation, Writing – Original Draft Preparation Yossra Dhaha Roles: Conceptualization, Formal Analysis, Investigation, Validation, Writing – Original Draft Preparation Amina Bouatay Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Resources, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Yosra Ben Boussef Roles: Supervision, Visualization, Writing – Review & Editing Nesrine Ben Sayed Roles: Conceptualization, Data Curation, Formal Analysis, Supervision, Writing – Original Draft Preparation Haifa Regaieg Roles: Conceptualization, Methodology, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Abderrahim Khelif Roles: Supervision, Validation, Writing – Review & Editing OPEN PEER REVIEW REVIEWER STATUS AWAITING PEER REVIEW This article is included in the Rare diseases collection. Abstract Background: In December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified and has subsequently been responsible for immense morbidity and mortality. This resulted in the development of vaccines in record time, potentially posing safety issues. Several cases of acquired hemophilia A (AHA) following coronavirus disease 2019 (COVID-19) vaccines have been described in the literature. AHA is a rare autoimmune disease due to the production of IgG autoantibodies to coagulation FVIII that burdens high morbidity and mortality. It is presumed mainly on identifying an increased activated partial thromboplastin time (aPTT), even without bleeding and is confirmed by determining a FVIII inhibitor. To the best of our knowledge, this is the first report of AHA after inactivated virus COVID-19 treated with low dose rituximab (RTX). Lower RTX doses may lead to shorter infusion duration, lower risk of adverse events and lower costs. Case presentation: We report a case of AHA occurring in a 69-year-old man 60 days after an inactivated Sinovac-coronavac COVID-19 vaccine. Diagnosis of AHA was based on clinical presentation and confirmed with prolonged activated partial thromboplastin time, Factor VIII deficiency and the presence of an FVIII inhibitor. Follow-up showed a significant clinical and biological improvement, aPTT was normalized as of 18 days of treatment with corticosteroids along with low dose rituximab. Conclusions: In the literature, the reported cases of AHA following COVID-19 vaccination occurred after Adenoviral Vector DNA- and SARS-CoV-2 mRNA-based COVID-19 vaccines. Here, AHA was presented following inactivated virus COVID-19 vaccine. AHA treated with low dose rituximab can limit occurrence of side effects and the cost of treatment. READ ALL READ LESS Keywords vaccines; COVID-19; Acquired hemophilia A, case report Corresponding Author(s) Emna Bouslama ( [email protected] ) Close Corresponding author: Emna Bouslama Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2024 Bouslama E et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Bouslama E, Ben Ismail H, Zahra K et al. Case Report: Acquired hemophilia A following COVID-19 vaccine [version 1; peer review: awaiting peer review] . F1000Research 2024, 13 :65 ( https://doi.org/10.12688/f1000research.128372.1 ) First published: 12 Jan 2024, 13 :65 ( https://doi.org/10.12688/f1000research.128372.1 ) Latest published: 12 Jan 2024, 13 :65 ( https://doi.org/10.12688/f1000research.128372.1 ) Introduction In December 2019 a global health crisis arose due to the highly contagious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), first starting in Wuhan and declared a worldwide pandemic on March 11th, 2020. Within the following years the coronavirus disease 2019 (COVID-19) has been responsible for immense morbidity and mortality resulting in over 6 million deaths around the globe. To date, there is no effective drug for treating COVID-19 despite many trials. 1 This situation resulted in an unprecedented race by pharmaceutical companies attempting to develop effective vaccines and as of November 2020, nine vaccines were already in phase III trials. 2 Subsequently a number of effective vaccines were given global authorization and were effective in reducing morbidity and mortality. 3 However, in order to facilitate and promptly reduce the impact of the pandemic on healthcare systems and global economy, a number of these vaccines were issued emergency use authorization . Shortly after initiation of COVID-19 vaccination a number of side-effects were reported, the most common being fatigue, muscle pain, headache and chills. 4 , 5 Over time, there have been several cases of more serious vaccine-related diseases such as myocarditis, 6 vaccine-induced immune thrombotic thrombocytopenia, 7 thrombotic thrombocytopenic purpura 8 and acquired hemophilia A (AHA). 9 Several cases of AHA following COVID-19 vaccines have been described in the literature. 9 – 14 Described as early as in the 18th century, 15 Hemophilia A is a rare bleeding disorder caused by a partial or total deficiency of coagulation factor VIII (FVIII). The concept of a lack of a plasma clotting factor dates back to 1840 16 and since then many extremely effective treatments have been developed. 17 As opposed to congenital hemophilia, AHA is a rare autoimmune disease due to the production of IgG autoantibodies to coagulation FVIII that burdens high morbidity and mortality. 18 The exact pathophysiology behind AHA remains uncertain, with a probable genetic predisposition and an association to certain underlying diseases (autoimmune disorders, respiratory diseases, allergic reactions). 18 , 19 We report a case of AHA occurring after an inactivated sinovac-coronavac COVID-19 vaccine. The patient was successfully treated with corticosteroids and low-dose rituximab in the acute phase. To the best of our knowledge, this is the first report of AHA after inactivated virus COVID-19 vaccine treated with low-dose rituximab in the acute phase. Case presentation A 69-year-old Tunisian retired man consulted the emergency department (ED) in June, 2022 for severe left leg pain limiting physical mobility due to a 5 * 6 cm large ecchymosis located at the left inner thigh, having spontaneously appeared 5 days prior to consultation with no recollection of trauma. The patient had no known personal medical history, a family history of gastric cancer (father) and no psycho-social relevant history. He had received the second dose of CoronaVac-SinoVac vaccine 60 days prior to consultation. The patient reported a small ecchymosis appearing and disappearing spontaneously 3 weeks after the vaccination. Further physical examination at the ED revealed the presence of two other ecchymoses: one at the inner face of the right forearm, starting at the wrist reaching the elbow, measuring 15 * 5 cm and the other at the left flank of the abdomen reaching the left iliac crest, measuring 40 * 12 cm ( Figure 1 ). Figure 1. Ecchymoses of the abdomen. Both of these were secondarily reported by the patient as having spontaneously started 5 days ago, with no context of trauma. Soft tissue ultrasound performed in regard of the initial ecchymosis at the left inner thigh because of a 5cm-asymmetry between the two thigh sizes eliminated the presence of a hematoma, revealing a hyperechoic infiltration of soft tissue located at the left inner tight. Laboratory findings performed at the ED were as follows: at the complete blood count, marcrocytic normochromic anemia with a hemoglobin at 8.4 g/dl; mean corpuscular volume, 103fl; mean corpuscular hemoglobin, 32 pg/cell; a normal platelet count, 475 109/L; the determination of Prothrombin Time (PT), prolonged activated partial thromboplastin time (aPTT) and coagulation factors were performed by coagulometric technique on ACL TOP. In our patient’s case, the hemostasis exploration showed an isolated and prolonged aPTT (100 sec/30 s; ratio = 3.33), that has not been corrected on the mixing test, with a normal Prothrombin Time PT = 75%. In front of the presumptive diagnosis of acquired hemophilia A (AHA), treatment by systemic corticotherapy of 80mg/day of prednisolone IV was immediately initiated as of the first day along with 3g/day of tranexamic acid IV for four weeks for the bleeding and transfusion of two packed red blood cells for the anemia. Bypass therapy was not considered if front of the absence of life-threatening bleeding. The patient was then transferred to the hematology department. Considering the patient’s age, the absence of history of bleeding or heparin-based treatment and the spontaneous occurrence of hematomas and ecchymoses along with the isolated aPTT prolongation, a deficiency of coagulation factors was suspected. Specific determination of coagulation factors was conducted, available 13 days later, revealing an isolated decrease of factor VIII (FVIII) activity (FVIIIc equal to 1%). Factor VIII deficiency was confirmed on two separate samples. The presence of an FVIII inhibitor was confirmed and titrated by the modified-Bethesada assay (BA) =121 Bethesada units/ml, affirming the diagnosis of AHA. The diagnosis of AHA was confirmed. After 17 days of corticosteroid treatment, a worsening of the ecchymosis was noted along with the non-improvement of the aTTP. The decision was then made to add low-dose rituximab (100mg/week) IV to the treatment plan. Which was administrated for a duration of 4 weeks. As for the etiology of the AHA, a panel of immunological testing (antinuclear antibodies, rheumatoid factor, anti-citrullinated protein antibodies) was negative. Hepatitis B, hepatitis C and human immunodeficiency virus serologic tests were negative and a malignant underlying disease was eliminated by a full-body computed tomography scan and negative tumoral markers (alpha fetoprotein, carcinoembryonic antigen, carbohydrate antigen 19-9). There was also no history of illicit drug intake or recent medication. The patient was later discharged after the first dose of rituximab and followed-up weekly at the out-patient clinic. Follow-up showed a significant clinical (healing of the ecchymoses and no reoccurrence of further signs of bleeding) and biological improvement, aPTT was normalized as of 18 days of treatment with corticosteroids along with rituximab. The detailed therapeutic schedule along with the biological improvement trends over 63 days are displayed in Figure 2 . There were no treatment-related adverse effects. Figure 2. Timeline treatment/aPTT (activated partial thromboplastin time). Discussion Acquired hemophilia A is a rare autoimmune disorder resulting from the production of autoantibodies against FVIII affecting mainly the elderly with an incidence of around 1.4 cases per 1.000.000 20 and carrying high morbidity and mortality especially if untreated. AHA should be suspected in front of an isolated prolonged aPTT with or without bleeding and confirmed by detecting a FVIII inhibitor. 19 Mostly with no identifiably trigger (43.6%-51.9% of cases), 19 AHA has been described to be associated with genetic predispositions, certain underlying diseases such as autoimmune disorders, respiratory diseases and malignancies or to a triggering factor such as infections or pregnancies. 18 , 19 Among the most noticeable global response to the COVID-19 pandemic was the celerity in developing vaccines with 92 COVID-19 vaccines under development and 21 authorized for use within only 15 months after the first official infection. 21 In the literature, there have been several cases of AHA occurring after COVID-19 vaccination. 10 – 14 There is not enough evidence about the causality of COVID-19 vaccines on the occurrence of particular auto-immune phenomena thus causing autoimmune diseases, so this remains unclear and debated. 22 The strength of this study is that, to the best of our knowledge, it reports the first occurrence of AHA after an inactivated COVID-19 vaccination (Sinovac-CoronaVac). In this case, it occurred 3 weeks after the second dose of the Sinovac-CoronaVac vaccine. All vaccine-related information was verified by consulting the patients’ vaccination certificate within the national register of vaccination (Government’s EVAX website). This study has some limitations. First, it reports the case of only one patient. Second, we do not have evidence that the AHA was caused by the vaccine. Currently, no post-vaccination surveillance programs recommend screening for clinical or biological signs of AHA, nor any other rare autoimmune disorders. Attention needs to be paid in the post-vaccine period mainly based on auto-surveillance. Apart from presentations with spontaneous or uncontrolled bleeding, clinicians must consider the diagnosis of AHA when faced with isolated prolonged aPTT. Treatment is focused on symptomatically treating any bleeding along with etiological treatment. In urgent situations such as uncontrolled bleeding, the administration of recombinant FVII activated or the activated prothrombin complex can help control bleeding. 19 The main treatment of AHA focuses on inhibitor eradication relying on immunosuppressive agents such as corticosteroids, rituximab and cyclophosphamide. 23 , 24 In the current case, low dose Rituximab (100 mg/week) was used along with corticosteroids rather than the standard dose (375mg/m2) to limit occurrence of side effects, mainly neutropenia, potentially dangerous to the elderly who have increased sensibility to infections. 25 Conclusions This article highlights potential safety concerns regarding COVID-19 vaccination. Although benefits acquired from vaccination highly outweighs the risks, post-vaccine surveillance is important to detect potential uncommon side-effects. Clinicians should consider AHA in front of prolonged aPTT with or without spontaneous bleedings, which, without prompt treatment, could be a life –threatening disease. Lower RTX doses may lead to shorter infusion duration, lower risk of adverse events and lower costs. Consent Written informed consent for publication of their clinical details and clinical images was obtained from the patient. Ethical approval This study received approval from the Institutional Research and Ethics Committee of the University Hospital Farhat Hached, Sousse. Data availability All data underlying the results are available as part of the article and no additional source data are required. References 1. Yaghoubi A, Amel Jamehdar S, Movaqar A, et al. : An effective drug against COVID-19: reality or dream? Expert Rev. Respir. Med. 2021 Apr; 15 (4): 505–518. Publisher Full Text 2. Prüβ BM: Current State of the First COVID-19 Vaccines. Vaccines. 2021 Jan 8; 9 (1): 30. Publisher Full Text 3. Lin DY, Gu Y, Wheeler B, et al. : Effectiveness of Covid-19 Vaccines over a 9-Month Period in North Carolina. N. Engl. J. Med. 2022 Mar 10; 386 (10): 933–941. Publisher Full Text 4. Analysis of COVID-19 Vaccine Type and Adverse Effects Following Vaccination - PubMed. http 5. Jęśkowiak I, Wiatrak B, Grosman-Dziewiszek P, et al. : The Incidence and Severity of Post-Vaccination Reactions after Vaccination against COVID-19. Vaccines. 2021 May 13; 9 (5): 502. Publisher Full Text 6. Chen JH, Ikwuanusi IA, Bommu VJL, et al. : COVID-19 Vaccine-Related Myocarditis: A Descriptive Study of 40 Case Reports. Cureus. 14 (1): e21740. 7. Aleem A, Nadeem AJ: Coronavirus (COVID-19) Vaccine-Induced Immune Thrombotic Thrombocytopenia (VITT). In: StatPearls. Treasure Island (FL):StatPearls Publishing;2022. Reference Source 8. Ben Saida I, Maatouk I, Toumi R, et al. : Acquired Thrombotic Thrombocytopenic Purpura Following Inactivated COVID-19 Vaccines: Two Case Reports and a Short Literature Review. Vaccines. 2022 Jul; 10 (7): 1012. Publisher Full Text 9. Leone MC, Canovi S, Pilia A, et al. : Four cases of acquired hemophilia A following immunization with mRNA BNT162b2 SARS-CoV-2 vaccine. Thromb. Res. 2022 Mar 1; 211 : 60–62. Publisher Full Text 10. Al Hennawi H, Al Masri MK, Bakir M, et al. : Acquired Hemophilia A Post-COVID-19 Vaccination: A Case Report and Review. Cureus. 14 (2): e21909. 11. Harenberg J, Marchetti M, Falanga A: Acquired Autoimmune Hemophilia Following SARS-CoV-2 Vaccines: Dual-Drug Effects on Blood Coagulation and the Scylla and Charybdis Phenomenon. Thromb. Haemost. 2021 Dec; 121 (12): 1555–1557. Publisher Full Text 12. Melmed A, Kovoor A, Flippo K: Acquired hemophilia A after vaccination against SARS-CoV-2 with the mRNA-1273 (Moderna) vaccine. Bayl Univ Med Cent Proc. 2022 Sep 3; 35 (5): 683–685. Publisher Full Text 13. Murali A, Wong P, Gilbar PJ, et al. : Acquired Hemophilia A following Pfizer-BioNTech SARS CoV-2 mRNA vaccine, successfully treated with prednisolone and rituximab. J Oncol Pharm Pract Off Publ Int Soc Oncol Pharm Pract. 2022 Sep; 28 (6): 1450–1453. Publisher Full Text 14. Soliman DS, Al Battah A, Al Faridi D, et al. : Acquired Hemophilia A Developed Post COVID-19 Vaccine: An Extremely Rare Complication. J Med Cases. 2022 Jan; 13 (1): 1–4. Epub 2022 Jan 17. PubMed Abstract | Publisher Full Text | Free Full Text 15. Ingram GI: The history of haemophilia*. Haemoph Off J World Fed Hemoph. 1997 Jun; 3 Suppl 1 : 5–15. 16. HÆMORRHAGIC DIATHESIS: SUCCESSFUL TRANSFUSION OF BLOOD. Lancet. 1840; 35 (896): 185–188. Publisher Full Text 17. Marchesini E, Morfini M, Valentino L: Recent Advances in the Treatment of Hemophilia: A Review. Biol Targets Ther. 2021 Jun 15; 15 : 221–235. Publisher Full Text 18. Pishko AM, Doshi BS: Acquired Hemophilia A: Current Guidance and Experience from Clinical Practice. J Blood Med. 2022 May 11; 13 : 255–265. Publisher Full Text 19. Kruse-Jarres R, Kempton CL, Baudo F, et al. : Acquired hemophilia A: Updated review of evidence and treatment guidance. Am. J. Hematol. 2017 Jul; 92 (7): 695–705. Publisher Full Text 20. Nowak KM, Carpinteiro A, Szalai C, et al. : Acquired Hemophilia A: A Permanent Challenge for All Physicians. Medicines. 2022 Mar; 9 (3): 21. Publisher Full Text 21. Muhar BK, Nehira J, Malhotra A, et al. : The Race for COVID-19 Vaccines: The Various Types and Their Strengths and Weaknesses. J. Pharm. Pract. 2022 Jun; 18 : 089719002210972. Publisher Full Text 22. Chen Y, Xu Z, Wang P, et al. : New-onset autoimmune phenomena post-COVID-19 vaccination. Immunology. 2022 Apr; 165 (4): 386–401. Publisher Full Text 23. Tiede A, Zieger B, Lisman T: Acquired bleeding disorders. Haemophilia. 2022; 28 (S4): 68–76. Publisher Full Text 24. Tiede A, Collins P, Knoebl P, et al. : International recommendations on the diagnosis and treatment of acquired hemophilia A. Haematologica. 2020 Jul 1; 105 (7): 1791–1801. Publisher Full Text 25. Yao Q, Zhu X, Liu Y, et al. : Low-dose rituximab in the treatment of acquired haemophilia. Hematol Amst Neth. 2014 Dec; 19 (8): 483–486. Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 12 Jan 2024 ADD YOUR COMMENT Comment Author details Author details 1 hematology departement, University Hospital Farhat Hached, Sousse, Sousse, Tunisia 2 Hematology laboratory, Sahloul University Hospital, Sousse, Tunisia Emna Bouslama Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Resources, Supervision, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Hajer Ben Ismail Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Resources, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Kmira Zahra Roles: Conceptualization, Data Curation, Methodology, Supervision, Validation, Writing – Review & Editing Nadia Sassi Roles: Conceptualization, Data Curation, Validation, Writing – Original Draft Preparation Yossra Dhaha Roles: Conceptualization, Formal Analysis, Investigation, Validation, Writing – Original Draft Preparation Amina Bouatay Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Resources, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Yosra Ben Boussef Roles: Supervision, Visualization, Writing – Review & Editing Nesrine Ben Sayed Roles: Conceptualization, Data Curation, Formal Analysis, Supervision, Writing – Original Draft Preparation Haifa Regaieg Roles: Conceptualization, Methodology, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Abderrahim Khelif Roles: Supervision, Validation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 12 Jan 2024, 13:65 https://doi.org/10.12688/f1000research.128372.1 Copyright © 2024 Bouslama E et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Bouslama E, Ben Ismail H, Zahra K et al. Case Report: Acquired hemophilia A following COVID-19 vaccine [version 1; peer review: awaiting peer review] . 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Extraction quality varies by source — PMC NXML preserves structure
cleanly, OA-HTML may include some navigation residue, and OA-PDF can
have broken hyphenation. The publisher copy
(via DOI)
is the canonical version.