Should People with Hemophilia Get the COVID-19 Vaccine?

Answers for the bleeding disorders community to frequently asked questions about the vaccine
Author: Donna Behen

When the Pfizer-BioNTech and Moderna COVID-19 vaccines became publicly available in December 2020, healthcare professionals around the country called them an important tool toward ending a pandemic that has caused more than 400,000 deaths and sickened millions of Americans.

But many people in the bleeding disorders community have questions about the vaccine, including whether it’s safe to take if you have hemophilia or another type of bleeding disorder. Below, answers to some of the most common questions about the COVID-19 vaccine.

Is the COVID-19 vaccine safe for people with bleeding disorders?

If you have a bleeding disorder, there are no contraindications to being vaccinated with either the Pfizer-BioNTech or the Moderna vaccine. Immune tolerance therapy, treatment for hepatitis C, and HIV and other conditions that require the use of immunosuppressive drugs also do not preclude a person from receiving either COVID-19 vaccine. If someone is taking part in a clinical trial, they should report their vaccination to the study investigators.

Does having a bleeding disorder put someone in the high priority group for getting the vaccine?

No, people with bleeding disorders are not at greater risk of contracting COVID-19 or developing a severe form of the disease, so they are not considered a priority group for vaccination. However, one argument for encouraging vaccination in the bleeding disorders community is that people who have COVID-19 can sometimes develop blood clots that require treatment with blood thinners, and this treatment would need to be carefully managed if someone also has a bleeding disorder.

Do people with bleeding disorders need to follow any special precautions when getting vaccinated?

If possible, the smallest gauge needle should be used (25 to 27 gauge) to administer the intramuscular vaccine. However, the use of an alternative needle is not always possible because some vaccines must be administered using the accompanying needle–syringe combination.

Pressure should be applied to the site for at least 10 minutes post-injection to reduce bleeding and swelling. Additionally, checking the injection area for two to four hours after vaccination is recommended to ensure that there is no delayed hematoma. Arm discomfort for one or two days after injection is normal, unless it worsens and is accompanied by swelling.

If you experience an allergic reaction to the vaccine (fever, warmth, redness, itchy skin rash, shortness of breath, or swelling of the face or tongue) you should contact your physician immediately or go to the nearest hospital emergency room right away, as these allergic reactions can be life-threatening. Patients with a history of allergic reactions to extended half-life clotting factor concentrates containing polyethylene glycol (PEG) should discuss vaccine choice with their physician because some vaccines contain PEG.

Should some people with hemophilia infuse before getting a vaccine?

Yes, if someone has severe or moderate hemophilia, the vaccine should be given after a factor VIII (FVIII) or factor IX (FIX) injection. But for patients with a basal FVIII or FIX level above 10%, no hemostatic precautions are required. Patients on emicizumab (with or without an inhibitor) can be vaccinated by intramuscular injection at any time without hemostatic precautions and without receiving a dose of FVIII.

Are there any special precautions for people with von Willebrand disease?

Depending on their baseline von Willebrand factor (VWF) ristocetin cofactor (RiCof) activity levels, patients with type 1 or 2 von Willebrand disease (VWD) should use therapies (such as DDAVP or tranexamic acid) in consultation with their hemophilia treatment center. Patients with type 3 VWD should be given a VWF-containing injection.

What about people with rare bleeding disorders?

All people with rare bleeding disorders (including those with thrombocytopenia and/or platelet function disorders) should be vaccinated. Patients on anticoagulants should have prothrombin time testing performed within 72 hours prior to injection to determine international normalized ratio (INR); if results are stable and within the therapeutic range, they can be vaccinated intramuscularly.