key: cord-0804109-mu3jp5si
authors: Cui, Dongyan; Zhang, Ai; Liu, Aiguo; Hu, Qun
title: Clinical findings in a patient with haemophilia A affected by COVID‐19
date: 2020-04-13
journal: Haemophilia
DOI: 10.1111/hae.14000
sha: 23c43c03fd03ea965f9a63d8ba2dda811c8bd14f
doc_id: 804109
cord_uid: mu3jp5si

At the end of 2019, a cluster of pneumonia patients were confirmed to be infected with a novel coronavirus, known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in Wuhan, Hubei Province, China. This infectious disease was designated as coronavirus disease 2019 (COVID-19). It rapidly spreads throughout the world. More than 80,000 cases have been reported in China and epidemics have grown in other countries.

On 22 January 2020, a 35-year-old man with a history of haemophilia A presenting with 2-day fever came to an emergency department in Wuhan, China. He was diagnosed with severe haemophilia A at 1-year old with FVIII: C 0.7%. He had no history of inhibitors and received factor replacement therapy on demand with low dosage.

Haemophilic arthropathy developed in his left knee joint with joint stiffness. The patient had no other underlying disease apart from a history of haemophilia A with his left knee as a target joint.

The patient described that before the onset of fever, aching pain developed in his limbs on 19 January 2020. Considering the underlying bleeding disorder, human coagulation FVIII (Consipin, 400 IU) was administered as usual at home, but his myalgia complaint remained unchanged. The next day (20 January 2020), he felt fatigue and presented with repeated low-grade fever with chills, recurrent vomiting and anorexia. The patient suspected that he might have infections with some bacteria, so he took oral amoxicillin and Chinese traditional medicines for 2 days on his own. However, his symptoms did not improve substantially. He disclosed that his mother developed fever and dry cough prior to his onset of symptoms and her condition had continued to worsen. The other family members also developed fever later except for his 3-year-old son. He decided to seek medical treatment because of suspicion of COVID-19.

The patient stated that he had never been out of Wuhan recently and denied a history of exposure to the Huanan Seafood Market. Given the history of his household members with fever or history of fever, he was triaged to a fever clinic exclusively for Unfortunately, owing to the isolation measures and inconvenience of traffic in Wuhan city, the patient has been isolated in his home since 23 January 2020 and from then on, no additional follow-up was available regarding his respiratory signs, the change of his chest imaging characteristics and the alteration of laboratory results, especially coagulation function and viral load.

More recently, the rate of new cases outside of China has outpaced than inside of China, which can be characterized as a pandemic.

Since the first report of these cases, more than 375 000 cases have were relatively uncommon. 5 In terms of laboratory results of infection, lymphopenia appeared to be most common, although the white blood cell count could vary. 6 Some inflammatory markers were affected by complicated factors. Moreover, SARS-CoV-2 infection was associated with coagulation activation with prolonged prothrombin time. 7 Oropharyngeal swab was suitable as samples for patients with haemophilia A rather than nasal swabs. Fortunately, the case herein presented with mild pneumonia and no bleeding events occurred.

This case report showed a recovery course of mild COVID-19 with no bleeding events under active treatment at home with antiviral agents, empirical antibiotics and supportive therapies, which may be a good example in home management. According to the product information for oseltamivir and cefdinir, adverse events of bleeding are not described. It seems that his haemophilia may not impact his ability to receive antimicrobial treatment. Haemophilia affects individuals lifelong. In patients with haemophilia with bleeding or suspected bleeding, the immediate goal is to raise the factor activity to a level sufficient to achieve haemostasis. 8 They do know when they have to receive administration of replacement factor. Moreover, when other health risks emerge, early replacement therapy is often thought to be beneficial. In China, many have access to potent prescription drugs at home, resulting in a different regime at home than in the hospital. For example, as for discomfort with myalgia in limbs at the onset of COVID-19 in this case, it would be more likely the occurrence of bleeding events because of the underlying bleeding disorder rather than infection of unknown cause. This case may benefit from the administration of FVIII at the onset of COVID-19 that results in zero bleeding events. Moreover, home management with active monitoring is appropriate for mild infected cases with haemophilia when they are adequately isolated at home. Importantly, if clinical conditions deteriorate, the patient should promptly be hospitalized.

In conclusion, clinical manifestations and outcomes of this mild COVID-19 patient with haemophilia were similar to that in non-haemophilic individuals. Mild infection of SARS-CoV-2 may not increase the occurrence of bleeding events in haemophilic cases. And such cases may benefit from administration of replacement factors at the onset of COVID-19. Despite the insufficient clinical investigation of these cases, the success of this case reveals that home management may be possible for them.

This work was partially supported by the Haemophilia Experience, Results, and Opportunities (HERO) Research Grant (Novo Nordisk).

The authors stated that they had no interests which might be perceived as posing a conflict or bias. 

National Health Commission of the People's Republic of China

World Health Organization. WHO Director-General's opening remarks at the media briefing on COVID-19 -23

SARS-CoV-2 infection in children: transmission dynamics and clinical characteristics

Imaging and clinical features of patients with 2019 novel coronavirus SARS-CoV-2

Clinical features of patients infected with 2019 novel coronavirus in Wuhan

Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series

Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan

Guidelines for the management of hemophilia