Q. Does having a bleeding disorder mean I’m at a higher risk of having coronavirus?
Patients with bleeding disorders when having concomitant underlying medical problems like such as cardiovascular disease, diabetes, obesity, liver disease, high blood pressure, asthma, etc may show increased severity of COVID symptoms.
Further, however, some patients with hemophilia may develop inhibitors and doctors may prescribe immune suppressants. These are medicines that suppress the immune system, which may make patients more susceptible to infections including COVID-19. However, patients are advised to stay on their current medications unless otherwise instructed by their physician. 1,2 .
Q. I am a hemophiliac, what measures I should take to protect myself from COVID and its variants?
When it comes to protecting yourself from exposure to COVID-19 or omicron or any coronavirus variants, you should follow the same recommendations as the rest of the general masses: regular handwashing with soap, sheltering in place, practicing social distancing, and using a mask at those times when it’s necessary to go outside the home.1,2
Q. If I get COVID-19, will it makes me more susceptible to blood clots or bruises?
‘Covid 19 coagulopathy’ is known to happen in a minority of individuals infected with covid. The cytokine storm activates the coagulation system and may lead to high levels of fibrinogen, high levels of factor VIII and von Willebrand, and extremely high levels of D-dimer. In general, patients with hemophilia have low levels of some of the coagulation factors which should in fact makes them less susceptible to blood clots. However, there is very limited data on whether hemophilia patients should be relatively protected from some of the thrombotic complications of COVID-19. However, patients on prophylaxis with factor VIII or emicizumab need to be followed very closely, because they will have pretty much the same inflammatory response as normal individuals. Their factor VIII might not go too high, but the fibrinogen will increase, the von Willebrand levels can increase, and D-dimers as well. Some of these patients might need anticoagulation also, like those with elevated D-Dimer levels, and thus require very close monitoring of drugs and factor VIII levels.3
Q. Is it safe to receive the COVID vaccine if I have a bleeding disorder?
If you are suffering from a bleeding disorder, there are no contraindications to being vaccinated with any of the vaccines available via the Emergency Use Authorization (EUA) status for intramuscular administration. It should be noted that immune tolerance therapy, treatment for hepatitis C, HIV, and other conditions including the use of immunosuppressive agents do not prevent a person from receiving the available vaccines.4
Q. Is it safe for people with low platelets Idiopathic Thrombocytopenic Purpura (ITP), or platelet function disorders to receive the COVID vaccine?
For individuals with pre-existing ITP (even if you are not on medication for your ITP and even if your platelet count is normal), it’s best to consult your general physician or hematologist prior to vaccination. As per the recommendation you received, you will be able to evaluate whether and when your platelet count should be checked after the first and/or second vaccination in addition to the baseline value.
Patients with low platelet disorders like ITP should take extra precautions when receiving the vaccine to prevent hematoma formation. A fine-gauge needle (25 or 27 gauge) should be used for the vaccination, followed by pressure on the site, without rubbing, for 10 minutes. For persons with other low platelet disorders or platelet function disorders, the recommendations for preparing for the vaccine may be similar or identical to those for persons with ITP.4
Q. Would I be in a priority group to receive the vaccine with a bleeding disorder?
No, you are generally not considered a priority group because individuals with bleeding disorders are not at a greater risk of contracting COVID-19 or developing a severe form of the disease. Thereby, general selection rules will apply for those with a bleeding disorder. Bleeding disorder patients in the risk groups identified by age, state of health, health care, or another essential worker will be vaccinated as a priority like others in the general population with the same risks. Priority groups will vary by state and country.2,4
Q. Will I have a bleed if I receive the vaccination?
The vaccination is administered intramuscularly, but the smallest gauge needle should be used (25-27 gauge), if possible. It is recommended to consult your general physician and hematologists prior to the vaccination. It might be preferable for you to infuse with a factor replacement product prior to or right after the vaccination and apply pressure for 10 minutes after the vaccination, but the requirement varies from patient to patient. In addition, patients with Von Willebrand disease or a rare bleeding disorder should consult with their hematologist with respect to the special precautions prior to receiving the vaccination. All rare bleeding disorder patients (including those with thrombocytopenia and/or platelet function disorders) should be vaccinated. Patients on warfarin should have prothrombin time testing performed within 72 hours prior to injection to determine the international normalized ratio (INR); if results are stable and within the therapeutic range, they can be vaccinated intramuscularly. Patients receiving other anticoagulants, such as enoxaparin, apixaban, dabigatran, and rivaroxaban should consult their prescribing doctor or practitioner for advice on how to safely prepare for the COVID-19 vaccine.
After the vaccination, the area should be thoroughly monitored for hematoma formation immediately for 10 minutes to reduce bleeding and swelling and by self-inspection 2-4 hours later at home to ensure that there is no delayed hematoma. Discomfort at the injection site is to be expected. Discomfort in the arm felt for 1-2 days after injection should not be alarming unless it worsens and is accompanied by swelling.
Any adverse events/ allergic reactions should be reported to the physician.2,4
Q. Where can I go to get the most reliable and current information and resources on bleeding disorders and COVID-19?
Visit the World Health Organization COVID-19 Information hub on its website for news, Centers for Disease Control and Prevention, The Indian Council of Medical Research (ICMR). In addition, visit the MINISTRY OF HEALTH & FAMILY WELFARE COVID-19 Resources page and the World Federation of Hemophilia’s COVID-19 WFH Announcements and Statements.
The universal phenomenon of blood clotting is well documented to be protective in external cellular/ tissue injury. However, the emergence of unusual thrombotic presentations in COVID-19 patients is the real concern. New clinical findings of SARS-CoV-2 pathogenesis are broadcasted every day, and one such mystery is the formation of blood clots in the various tissues and organs of COVID-19 patients, which need critical attention. Moreover, bleeding disorders don’t make you more susceptible to coronavirus or to any viral infection per se, however, you may show severe symptoms as in patients without bleeding disorders if you have concomitant severe diseases, such as cardiovascular disease, diabetes, obesity, liver disease, high blood pressure, asthma or on immunosuppressants etc. Publisher’s name- Dr. Dangs Lab
Disclaimer: This content including advice provides generic information only. It is in no way a substitute for a qualified medical opinion.