How haemophilia A impacts severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) treatment: a case report
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How haemophilia A impacts severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) treatment: a case report Ezio Zanon1 · Samantha Pasca1 · Elena Campello2 · Luca Spiezia2 · Roberto Vettor3 · Paolo Simioni2 Accepted: 8 July 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The typical symptoms of COVID-19 mimic those of the common season flu. In addition, several changes in the coagulation processes have been observed. To date, it’s not fully clear how COVID-19 may affect patients with hereditary bleeding disorders. Anticoagulation in patients with haemophilia is still debated, but in this case could be needed. We are reporting a case of an elderly patient with mild haemophilia A hospitalized for Sars-Cov-2. On the 15th day of hospitalization, we observed an increase of all coagulation parameters. An antithrombotic prophylaxis at low dosage was immediately started, then increased at prophylactic dosage. Even if much more data are needed to ascertain the real thrombotic risk of haemophilia A in COVID-19 patients, it’s clear that the FVIII and vWF should be strictly monitored in order to promptly establish an adequate treatment and avoid the onset of thromboembolic events, even fatal, causing many deaths in COVID-19 patients. Keywords COVID-19 · Coronavirus · SARS-Cov-2 · Coagulation · Haemophilia A · Bleeding disorders
Highlights • Sars-CoV-2 can cause some changes in coagulation pro-
cesses in affected patients.
• To date it is not completely clear how this disease
impacts on patients with hereditary bleeding disorders.
• Haemophilia seems to confer a protection from hyperco-
agulable state caused by COVID-19.
• But our mild haemophilia patient reached high levels
of FVIII, vWF and D-dimer, which required thromboprophylaxis. • In haemophilia subjects with Sars-CoV-2 a close monitoring of the all coagulation parameters is needed to correctly balance between haemorrhagic and thrombotic risk.
* Ezio Zanon [email protected] 1
Medicine Department, Haemophilia Centre, Padua University Hospital, Via Giustiniani, 35128 Padua, Italy
2
Centre for Haemorrhagic and Thrombotic Diseases, Medicine Department, Padua University Hospital, Padua, Italy
3
Medicine Department (DIMED), Padua University Hospital, Padua, Italy
Brief communication A novel coronavirus (COVID-19) causing severe pneumonia emerged in Wuhan, Hubei Province (China) in late 2019 and quickly spread worldwide shortly thereafter. Italy diagnosed its first COVID-19 patient in February 2020, and the Istituto Superiore di Sanità (ISS) reports about 230,000 infections among the Italian population, with the total number of deaths exceeding 33,000 (1). The typical symptoms of COVID-19 mimic those of the common season flu with fever, cough, dyspnoea, enteric disorders. However, these symptoms can progress rapidly to interstitial pneumonia causing severe respiratory distress requiring hospitalization and, in some cases, even ventilatory support in the intensive care unit. In addition to respiratory complic
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