Canadian Immunization Guide
Seventh Edition - 2006

[Previous] [Table of Contents] [Next]

Part 3
Recommended Immunization

Immunization of Persons with Bleeding Disorders

While certain factors must be considered before immunizing individuals with bleeding disorders, these persons should receive all the recommended immunizations according to routine schedules. For all children, before giving the first immunization at 2 months of age, clinicians should ensure that there are no symptoms or signs compatible with an undiagnosed bleeding disorder. If these are present, a diagnosis should be established before commencing immunization.

Individuals receiving low doses of acetylsalicylic acid therapy and long-term anticoagulation with either coumadin or heparin are not considered to be at higher risk of complications and may be safely immunized through either the intramuscular or subcutaneous route without discontinuation of their anticoagulation therapy.

Route of administration of immunization

The risks and benefits of administering intramuscular injections to individuals with a bleeding disorder must be weighed before choosing the route of administration. In general, subcutaneous injections are preferred over intramuscular injections in this population and should be considered when the efficacy is known to be the same for both routes, especially if an individual has a bleeding disorder that is not correctible. For more information on immunizations that are available for subcutaneous administration please refer to Table 1, in the General Considerations chapter. In individuals with non-correctible bleeding disorders intramuscular gluteal injections should be avoided if possible.

Correction of bleeding disorder

When immunizations are to be given by the intramuscular route or when there is a concern that injection may stimulate bleeding, the immunization should be given following anti-haemophilia therapy or correction of the bleeding disorder when possible.

Method of immunization

Immunization should be carried out using a fine-gauge needle of appropriate length. After the injection, firm pressure should be applied, without rubbing, to the injection site for at least 5 minutes.

Immunizations to be considered in individuals with bleeding disorders

Although currently available plasma-derived products are all tested for viral contamination prior to administration, any patient with a bleeding disorder should still be considered at higher risk of contracting hepatitis A or B and should be offered these vaccines. Even when recombinant therapeutic products are being used, immunization is still recommended in case the recombinant supply is unavailable and patients are required to switch to plasma-derived products at short notice. Please refer to the Hepatitis A chapter and Hepatitis B chapter for information on dosage.

Selected references

Makris M, Conlon CP, Watson HG. Immunization of persons with bleeding disorders. Haemophilia 2003;9(5):541-46.

[Previous] [Table of Contents] [Next]