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Background: Acquired hemophilia A (AHA) is a rare autoimmune bleeding disorder that occurs in a sporadic, nonhereditary pattern. It is caused by circulating autoantibodies against clotting factor VIII that are triggered by several conditions. Moreover, AHA is clinically distinct from the inherited form of hemophilia A, with a different natural history and management approach, necessitating a high-index of suspicion in at-risk patients. Coronavirus disease 2019 (COVID-19) has emerged as a multisystemic disease whose manifestations are continuously being evaluated. There are few case reports of AHA associated with COVID-19 infection, while one case of AHA has been associated with COVID-19 vaccination. Similarly, deep venous thrombosis (DVT) frequently complicates COVID-19 infection, but two cases of DVT have been reported following COVID-19 vaccination. We report the occurrence of both AHA and DVT in a 63-year-old male patient within one week of receiving his first dose of the Pfizer-BioNTech SARS-CoV-2 mRNA vaccine. Case Description: Patient is a 63-year-old male who presented with a 3-day history of left lower extremity (LLE) swelling and pain. He was hemodynamically stable, but examination showed exquisite tenderness, ecchymosis, and pitting edema at the calf of the LLE. He had normal platelet counts at presentation but had mild anemia (11.9 g/dL) and elevated activated partial thromboplastin time (APTT) of 68.0 seconds. Venous Doppler ultrasound showed acute DVT in the left popliteal vein, necessitating commencement on heparin drip. He developed progressively worsening hematomas, symptomatic anemia that required red cell transfusions, and persistently elevated APTT despite stopping the heparin drip. Work up for pulmonary embolism, malignancy, and disseminated intravascular coagulopathy (DIC) were negative. Antiphospholipid antibodies and lupus anticoagulant were also negative. He had low factor VIII levels, tested positive for factor VIII inhibitor, and PTT mixing studies were consistent with acquired factor inhibitor. Treatment involved administration of Factor Eight Inhibitor Bypassing Activity (FEIBA) as well as intravenous methylprednisolone and cyclophosphamide. Following resolution of active bleeding with evidence of stable hemoglobin concentration, he was discharged home on oral prednisone and cyclophosphamide. Conclusion(s): This case report highlights the possibility of AHA and DVT as rare, potentially life-threatening adverse events that could occur following COVID-19 vaccination, which is currently the most effective tool employed in controlling the COVID-19 pandemic.Copyright © Annals of Blood. All rights reserved.
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Purpose: Pre-eclampsia and eclampsia (PE/E) are rising in Sub-Saharan Africa, including Nigeria. This study aims to evaluate the availability and logistics management of sixteen items from the Nigerian essential medicine list required for managing these conditions. Design/Methodology/approach: A cross-sectional study in 50 health-care facilities in Lagos State, Nigeria, at the beginning of the COVID-19 pandemic by interviewing the facility's main person in charge of health commodities. Data were recorded during the visit and in the previous six months using the adapted Logistics Indicators Assessment Tool (LIAT). In addition, descriptive analysis was conducted based on the World Health Organization availability index. Findings: The availability of 13 (81%) of the commodities were high, and 3 (19%) were relatively high in the facilities, stock out rate during the visitation and previous six months varied with the commodities: urinalysis strip (22%) and (40%), hydralazine (20%) and (20%), labetalol injection (8%) and (20%), labetalol tablet (24%) and (24%) and sphygmomanometer (8%) and (8%). No stock out was recorded for 11 (69%) commodities. All the facilities observed 9 (75%) out of the 12 storage guidelines, and 36 (72%) had a perfect storage condition score. Limitations/Implications: Current state of PE/E health commodities in the selected facilities is highlighted, and the strengths and weaknesses of the supply chain in these health facilities were identified and discussed. Originality/value: These commodities' availability ranged from reasonably high to very high. Regular supportive supervision is germane to strengthening the logistics management system for these commodities to prevent the negative impact on the health and well-being of the people during the COVID-19 pandemic and post-pandemic. © 2023, Adesola Olalekan, Victor Igweike, Oloruntoba Ekun, Abosede Adegbite and Olayinka Ogunleye.
ABSTRACT
TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2 virus, has emerged as a leading cause of death globally. The most reported initial symptoms are cough, fever, dyspnea, and fatigue. Hemoptysis is atypical in COVID-19. We report cases of COVID-19 pneumonia presenting with hemoptysis in two unrelated men. CASE PRESENTATION: Patient-I was a 60-year-old nonsmoker with no known comorbidities that tested positive for COVID-19 three days earlier. He presented with 10-day history of fever and cough with blood-streaked sputum that progressed to coughing frank blood. He was febrile (103.0°F) and saturating at 95% inspiring ambient air. Chest examination revealed crackles at the right lower lung field. Laboratory evaluation noted normal platelet count, elevated D-dimer (445 ng/mL) and elevated C-reactive protein (17.2 mg/dL). Chest x-ray showed patchy opacification at the right mid and lower lung zones. He was treated conservatively. The hemoptysis resolved by day 2 and he was discharged on day 5.Patient-II, a 56-year-old former smoker with hypertension and diabetes, was diagnosed with COVID-19 twelve days earlier and developed acute hypoxic respiratory failure requiring a 5-day hospitalization at a different hospital. He presented with 2-day history of worsening shortness of breath and cough with bloody sputum. He was afebrile (98.9°F) and saturating at 67% inspiring ambient air. Chest examination revealed bilateral crackles. Laboratory evaluation noted normal platelet count, elevated D-dimer (5,876 ng/mL) and elevated C-reactive protein (21.7 mg/dL). Chest x-ray showed patchy opacification in the mid and lower lung zones bilaterally. He was treated with high-flow oxygen, Tocilizumab, Remdesivir and Dexamethasone. The hemoptysis resolved by day 2. On day 14, he was discharged on 3 L/min of supplemental oxygen.In both patients, chest CT angiography showed no evidence of acute pulmonary embolism. DISCUSSION: The pathogenesis of hemoptysis in COVID-19 is attributed to pulmonary embolism and/or alveolar destruction – the former being more common. Only 1–5 % of COVID-19 patients on hospital admission develop hemoptysis, with incidence as high as 13% in COVID-19 patients with concurrent pulmonary emboli. SARS-CoV-2 induces a pro-inflammatory and hypercoagulable state, thus increasing risk of thromboembolic events. Both of our patients had elevated D-dimer levels, but imaging showed no evidence of pulmonary emboli, thus suggesting alveolar destruction as the more likely cause of hemoptysis. Studies indicate that presentation with hemoptysis in COVID-19 patients increases the odds of severe illness 1.8-4.0 times. Host factors, such as presence and absence of comorbidities, likely played a significant role in determining disease severity/outcome for these patients. CONCLUSIONS: These cases highlight the relevance of recognizing hemoptysis as part of the clinical symptomology of COVID-19 pneumonia. REFERENCE #1: Peys E, Stevens D, Weygaerde YV, et al. Haemoptysis as the first presentation of COVID-19: a case report. BMC Pulm Med. 2020;20(275):1-4. https://doi.org/10.1186/s12890-020-01312-6 REFERENCE #2: Ozaras R, Uraz S. Hemoptysis in COVID-19: pulmonary emboli should be ruled out. Korean J Radiol. 2020;21(7):931-933. https://doi.org/10.3348/kjr.2020.0477 REFERENCE #3: Jiang F, Deng L, Zhang L, Cai Y, Cheung CW, Xia Z. Review of the clinical characteristics of coronavirus disease 2019 (COVID-19). J Gen Intern Med. 2020;35(5):1545-1549. doi:10.1007/s11606-020-05762-w DISCLOSURES: No relevant relationships by Oluwafemi Ajibola, source=Web Response No relevant relationships by Nneka Chukwu, source=Web Response No relevant relationships by Olushola Ogunleye, source=Web Response No relevant relationships by Hary Suseelan, source=Web Response