COVID-19 Vaccine Recommendations for Patients with Blood Disorders

Which COVID-19 vaccine can be administered for issues related to red blood cells?

Hello Doctor, I would like to inquire whether I can receive vaccinations given my hereditary thalassemia.
Additionally, which vaccine would you recommend as the most appropriate? My annual health check reports indicate that my red blood cell count (RBC) is in the red zone at around 580, with an average corpuscular volume (MCV) of about 68, an average corpuscular hemoglobin (MCH) of about 21, and an average corpuscular hemoglobin concentration (MCHC) of around 30.
I often experience symptoms such as rapid heartbeat, palpitations, and dizziness.
I have also felt sudden tightness in my heart and a sensation of my heart stopping, but cardiac evaluations have shown no issues.
In the past, I have experienced dizziness followed by seeing stars and fainting (more than once).
I previously had symptoms of hyperventilation, but my condition has improved in recent years, and I no longer take medication (I only took half a sedative when I felt really unwell).
My pulse tends to be on the higher side, normally around 75, but this year it was 85 during my health check.
As a child, I experienced significant swelling and bruising after vaccinations (in both my arm and buttocks), and I have a congenital tendency for lymph nodes in my neck to swell due to inflammation or colds.
I would like to know if these factors would affect my ability to receive the COVID-19 vaccine, particularly concerning my red blood cell count and the issue of persistent swelling after injections.
Thank you, Doctor.

Ann, 30~39 year old female. Ask Date: 2021/11/23

Dr. Liao Yaopan reply Family Medicine

Hello, the situations mentioned above are generally not considered absolute contraindications for vaccination.
However, individual reactions to vaccines can vary.
It is important to observe after vaccination.
Online consultations do not equate to in-person medical visits and cannot provide diagnoses or treatment recommendations.
Changhua Hospital cares about you.

Reply Date: 2021/11/23

More Info

When considering COVID-19 vaccination for patients with blood disorders, such as hereditary Mediterranean anemia, it is essential to evaluate both the individual's specific health conditions and the potential risks associated with vaccination. Based on your description, it appears that you have a history of elevated red blood cell counts, episodes of palpitations, dizziness, and a tendency to develop bruising after vaccinations.
Firstly, it is important to note that individuals with blood disorders, including those with hereditary conditions like Mediterranean anemia, are generally encouraged to receive the COVID-19 vaccine. Vaccination can help protect against severe illness from COVID-19, which is particularly important for individuals with underlying health conditions. The vaccines currently available, such as Pfizer-BioNTech (BNT), Moderna, and AstraZeneca (AZ), have been shown to be effective in preventing COVID-19 and its complications.

In terms of which vaccine to choose, there are a few considerations:
1. Vaccine Type: mRNA vaccines (Pfizer-BioNTech and Moderna) have been associated with fewer adverse effects related to blood clotting compared to viral vector vaccines like AstraZeneca. Given your concerns about bruising and previous reactions to vaccinations, mRNA vaccines may be a preferable option for you. They have a good safety profile and are effective in providing immunity against COVID-19.

2. Monitoring and Consultation: Given your history of elevated red blood cell counts and episodes of dizziness and palpitations, it is crucial to consult with your healthcare provider before vaccination. They can assess your overall health, review your blood work, and determine if any additional precautions are necessary. It may also be beneficial to have a hematologist involved in your care to provide tailored advice regarding vaccination.

3. Potential Reactions: Your history of developing bruises easily after vaccinations is something to discuss with your doctor. While it is common for some individuals to experience localized reactions such as swelling or bruising at the injection site, your tendency to bruise easily may warrant closer observation. Your healthcare provider may recommend strategies to minimize bruising, such as applying pressure to the injection site after vaccination.

4. Timing of Vaccination: If you are experiencing any acute symptoms or if your blood disorder is currently unstable, it may be advisable to wait until your condition is more stable before receiving the vaccine. Your healthcare provider can help determine the best timing for vaccination based on your health status.

5. Post-Vaccination Monitoring: After receiving the vaccine, it is important to monitor for any unusual symptoms. If you experience significant bruising, swelling, or any other concerning symptoms, you should contact your healthcare provider for further evaluation.

In summary, while individuals with hereditary Mediterranean anemia can generally receive the COVID-19 vaccine, it is essential to consult with your healthcare provider to determine the most appropriate vaccine type and to discuss any specific concerns related to your health history. Vaccination is a critical step in protecting yourself from COVID-19, especially given the potential risks associated with the virus itself. Your healthcare team can provide personalized recommendations to ensure a safe vaccination experience.

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