Australian Government Department of Health and Ageing Immunisation HandbookAustralian Government Department of Health and Ageing crest. Link to the Immunise Australia Program homepage.

2.3 Groups with special vaccination requirements

2.3.6 Vaccination of patients with bleeding disorders

Please note: due to continuous updates being made to the Immunisation Handbook, the page number on the electronic version will not always match the hard copy version.


Intramuscular injection may lead to haematoma formation in patients with disorders of haemostasis, and to pressure necrosis, muscle contractures or nerve compression in patients with severe coagulopathies. Children with inherited coagulopathies should receive factor replacement before intramuscular injection. Unless warfarin doses are known to be stable, patients receiving this anticoagulant should have prothrombin times measured before intramuscular injections, which should be deferred if the INR (international normalised ratio) is greater than 3.0. Patients with platelet counts of less than 50 x 109/L should not receive intramuscular injections.

The subcutaneous route could be considered as an alternative to the intramuscular route in patients with bleeding disorders; seek expert advice.19

References

19. Centers for Disease Control and Prevention (CDC). General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). [erratum appears in MMWR Morb Mortal Wkly Rep. 2006 Dec 8;55(48):1303]. MMWR - Morbidity & Mortality Weekly Report 2006;55(RR-15):1-48.