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A 1971 case report (1) shows that a hemophiliac could tolerate a 14-day course of subcutaneous rabies vaccine injections. This particular report mentions only vaccine and not immunoglobulin.

In 1971, a 25 year old hemophiliac in Rochester, New York, was admitted after being bitten by a stray dog. The attending doctors first treated his wounds and stablilized his hemophilia by giving him Factor VIII clotting factor concentrate, the factor the patient was deficient for.

48 hours later, they started a 14-day vaccine course of subcutaneous injections of rabies vaccine using a 25-gauge needle. After each injection, they applied pressure to the injected area for 15 minutes. They report the patient developed expected injection site reaction and no other complications.

Though the patient, a classic Factor VIII deficiency, had a history of spontaneous Hemarthrosis, i.e., bleeding into joint spaces, the attending doctors were successful using routine vaccine immunization without requiring simultaneous clotting factor infusions. The authors concluded rabies vaccine administration needn’t be altered for hemophiliacs.

Current guidelines for rabies vaccine recommend intramuscular, not subcutaneous, injection route (2). This may be a change since 1971. Guidelines recommend human rabies immunoglobulin be infused locally at the wound site with additional amount injected intramuscularly at a site different from the vaccination site (2). It’s likely the intramuscular route would work for hemophiliacs as well since it is a single shot unlike the vaccine which is four separate shots on four separate days.

Bibliography

1. Smith, Charles M., and Robert T. Breckenridge. “Rabies Prophylaxis in Hemophilia.” JAMA 216.12 (1971): 2016-2016.

2. CDC – Medical Care – Rabies

https://www.quora.com/What-is-the-route-of-administration-of-rabies-immunoglobulin-in-hemophilia-patients-during-dog-bite/answer/Tirumalai-Kamala

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