Pakistan Haemophilia Patients Welfare Society Rawalpindi 
Haemophilia Treatment Center (HTC)
COVID - 19  Vaccination Guidelines for People  with Inherited Bleeding Disorders 
 Author : Dr Tahira Zafar , Director HTC 
 No contraindication to vaccination in  People with inherited  bleeding disorders. All people including Rare Bleeding Disorders & Platelet  Disorders should be vaccinated.
Patients with Hepatitis C or on treatment for Hepatitis C should also be vaccinated .
All People  with Inherited Bleeding Disorders to be notified to get themselves registered for vaccination per Govt. of Pakistan ,Dept. of health guidelines.
 When the Code No. ,date & vaccination center becomes available ,they should be advised to contact their HTC for guidance .
HTC guidelines are as follows :
1.  The vaccine  will be administered intramuscularly with a syringe with its own needle . Pressure to be applied to the site of injection for atleast 10 minutes to reduce bleeding and swelling
2 .Check the site  2-4 hours  after injection for any swelling .In case of any pain(slight arm discomfort for 1-2 days after injection is normal )accompanied by swelling report to your HTC 
3.If the site of injection has a rash & is itchy, there is shortness of breath, or swelling of the face or tongue (allergic reaction) report to your HTC or nearest hospital emergency immediatly  
4. People with severe /moderate haemophilia will require factor concentrates prior to vaccination . Contact your HTC ( Aim to keep F VIII & IX levels above 10% 
5. Patients with Type 1 or 2 Willebrand disease (VWD), depending on their baseline von Willebrand factor (VWF) ristocetin cofactor (RiCof) activity levels, should use therapies (i.e. tranexamic acid, DDAVP unavailable in Pakistan ), in consultation with their hemophilia treatment centre. Patients with Type 3 VWD should be given a VWF-containing injection.(Aim to keep VWF level above 10%) 

6. Patients on Emicizumab (with or without inhibitors )can be vaccinated without factor concentrate cover 

Reference
WFH COVID Vaccination guidance for people with hemophilia. December 22 ,2020