Information about COVID-19 for hemophilia patients
Fact-checked by People with hemophilia do not appear to have a clearly higher risk of developing COVID-19 or experiencing severe illness from the infection compared with the general population. Still, because complications can occur, health authorities recommend that individuals with this bleeding disorder stay up to date on their COVID-19 vaccinations and contact their hemophilia care team if they become infected.
More formally known as coronavirus disease 2019, COVID-19 is a contagious viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It causes symptoms that mirror those of a cold or flu, including fever or chills, cough, sore throat, congestion or runny nose, headache, loss of taste or smell, and fatigue.
Since the global pandemic from 2020 to 2023, the number of COVID-19 infections has dropped, though it remains a common illness.
Does hemophilia increase the risk of severe COVID-19?
For many, COVID-19 symptoms remain mild and resolve without special treatment, though a small portion of patients become critically ill and require intensive care.
The most recent data from a U.S. registry study suggest that people with COVID-19 and hemophilia face no greater risk of severe illness — including the need for oxygen therapy or intensive care unit admissions — or death than the general public. As in other populations, the main risk factors for these complications in hemophilia patients include older age and preexisting health conditions, such as heart failure, cancer, or liver disease.
Bleeding and blood clotting risks
In general, COVID-19 does not appear to significantly alter hemophilia symptom severity or bleed frequency. However, if the virus causes severe coughing, patients face an elevated risk of bleeding in the head, throat, or lungs, requiring careful monitoring.
The immune system’s response to COVID-19 can cause severe inflammation that increases the risk of a blood clotting complication called venous thromboembolism (VTE). Unlike blood clots that form normally to stop bleeding after an injury, these clots develop inside blood vessels and can restrict blood flow.
At first, scientists hypothesized that because people with hemophilia have reduced blood clotting ability, they might face a lower risk of this complication.
A larger body of data now shows the opposite — hemophilia does not alter the risk of COVID-19-related VTE compared with the general population. This may be because the mechanisms of clotting in VTE are independent of the clotting proteins that are missing in hemophilia.
Certain hemophilia medications, particularly Hemlibra (emicizumab-KXWH), can interfere with lab tests used to monitor for clotting complications during a COVID-19 infection. Patients should always inform care providers conducting these tests about their blood disorder.
Treatment considerations
In general, experts recommend that patients continue their usual hemophilia treatment plan, including factor replacement therapy and other medications, if diagnosed with COVID-19. Clotting factor continuity during COVID-19 plays a vital role in preventing potential bleeding complications.
Standard treatments for symptomatic COVID-19 can be used in people with hemophilia. However, the blood thinners commonly used to prevent blood clotting complications in people hospitalized with COVID-19 should be used with caution. If required, they should be given in combination with factor replacement therapy to manage bleeding risk.
Hemophilia and COVID-19 vaccine safety
COVID-19 vaccines are considered safe and effective for people with bleeding disorders and are generally recommended for the hemophilia population.
Global health authorities agree that people with bleeding disorders are no more susceptible to COVID-19 than the general population, so standard vaccination recommendations apply; however, patients should always consult their care team for individual guidelines.
COVID-19 vaccines are injected into a muscle. People with moderate or severe hemophilia are advised to receive a dose of factor replacement therapy beforehand to prevent injection-site bleeding. People on other medications, such as Hemlibra, may not need this precaution.
Individuals should inform the care provider administering the vaccination about their bleeding disorder, as the administrator should use the smallest possible needle. To reduce the risk of bleeding after the shot, individuals should:
- apply direct pressure over the injection site for 10 minutes
- thoroughly check the injection site after several minutes and a few hours for signs of bleeding or swelling
Polyethylene glycol (PEG), a stabilizing ingredient in some COVID-19 vaccines, can cause allergic reactions. Such reactions are rare, and people with hemophilia do not face an increased risk of experiencing them. There is no reason to avoid vaccination unless a person has a known history of severe reactions to PEG-containing products, including certain extended half-life factor replacement therapies.
Some evidence suggests that COVID-19 vaccination could be a very rare trigger for acquired hemophilia, a form of the bleeding disorder caused by an autoimmune reaction. However, the same holds true for a COVID-19 infection, and the benefits of vaccination outweigh the risks for most people.
Hemophilia News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
