Haematology conditions and COVID-19

Haematology conditions and COVID-19

Last updated 1 Jun 2020

Author: Dr Tony Williams, Consultant Occupational Physician, Working Fit Ltd

 

Haematological condition

 

 

Vulnerability

 

 

References

 

Allogenic transplant (using donor stem cells) in the last two years Very high risk (shield)

 

https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19

https://bloodcancer.org.uk/support-for-you/coronavirus-covid-19/coronavirus-blood-cancer/

Anaemia: rare, inherited

Pyruvate kinase deficiency

Congenital, dyserythropoetic anaemia who have had a splenectomy and are at particularly high risk due to iron overload (see below)

Very high risk (shield) https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19
Anticoagulants Low/standard https://thrombosisuk.org/news/post.php?s=2020-03-20-blood-clots-thrombosis-and-covid-19

anticoagulants themselves don’t place patients at risk for COVID-19.

Aplastic anaemia/bone marrow failure

 

All patients who are neutropenic, and especially those with severe and very severe neutropenia, neutrophil count < 0.5

 

All patients being treated with immunosuppressive drugs, notably antithymocyte globulin (ATG) and ciclosporin

All patients who are lymphopenic: this will include patients with acquired AA being treated with ATG, ciclosporin, and also some patients with inherited/constitutional AA/BMF

Constitutional AA/BMF:

Especially GATA2 deficiency patients who are monocytopenic, lymphopenic and often also neutropenic

Inherited telomeropathies/dyskeratosis congenita: some may have immunodeficiency with lymphopenia in the absence of neutropenia, affecting B, NK cells and T cells

Schwachmann-Diamond syndrome patients commonly are neutropenic, and may also have immune deficiency

All patients on steroids

All patients undergoing allogeneic haemopoietic stem cell transplantation (HSCT) for AA/BMF, or who have had a HSCT

Add 7 years This figure is provisional and the vulnerability may be greater.
Autologous transplant in last year Add 14 years This is provisional and may change
B12 deficiency see pernicious anaemia below
Blood cancer (Leukaemia, Lymphoma, Myeloma)

Diagnosed less than one year ago

on immunosuppression medication after transplant

history of GvHD

ongoing immunodeficiency after transplant

Add 14 years This is provisional and may change
Blood cancer

Diagnosed 1-4.9 years ago

Add 13 years This is provisional and may change
Blood cancer

Diagnosed ≥5 years ago

Add 7 years This is provisional and may change
Clotting disorders Low/standard https://news.wfh.org/specific-risks-of-covid-19-to-the-bleeding-disorders-community/

No increased susceptibility to infection has been found in immunocompetent patients with bleeding disorders

Diamond Blackfan anaemia and

high doses of steroids, ≥15mg average prednisolone daily

associated cellular or humoral immunodeficiency

adrenal insufficiency or steroid replacement

iron overload (see below), or significant congenital heart disease due to DBA.

BMT within 6 months or still using immunosuppressive drugs

Very high risk (shield) https://b-s-h.org.uk/media/18174/nhp-covid-19-dbaversion-224032020.pdf

https://b-s-h.org.uk/media/18201/statement-from-the-haemoglobinopathy-co.pdf

Diamond Blackfan anaemia

without complications listed above

Very high risk

Social distancing and

work from home even if key worker

https://b-s-h.org.uk/media/18174/nhp-covid-19-dbaversion-224032020.pdf
Hameochromatosis Low/Standard

unless other complications or co-morbidities

https://www.haemochromatosis.org.uk/cornonavirus-update-march-2020
Haemophilia Low/Standard https://haemophilia.org.uk/2020/03/17/updated-coronavirus-information/

https://www.hemophilia.org/Newsroom/NHF-Community-News/Health-and-Wellness-Update-5-from-Dr-Valentino

IgA Deficiency

isolated, with no other immunodeficiency

Low/Standard https://www.ukpin.org.uk/docs/default-source/default-document-library/ukpin_risk_stratification_covid19_finalac6baa9cd4eb6fe9b40eff00005026c1.pdf
Immune thrombocytopaenia and treatment with

Azathioprine

Cyclosporine

Mycophenolate mofetil

Prednisolone

Rituximab in past 12 months

Vincristine

And/or splenectomy

Very high or high https://b-s-h.org.uk/media/18202/information-for-patients-with-itp-regarding-coronavirus-corvid19-23-3-20.pdf

https://www.hematology.org/covid-19/covid-19-and-ttp

Immune thrombocytopaenia

Including treatment with

Eltrombopag (Revolade)

Romiplostim

As these will not affect the immune system.

Low/standard https://b-s-h.org.uk/media/18202/information-for-patients-with-itp-regarding-coronavirus-corvid19-23-3-20.pdf

https://www.hematology.org/covid-19/covid-19-and-ttp

Iron overload

T2*<15ms, previous or current impaired LV function or other cardiac complications

severe iron overload LIC>15mg/g DW or ferritin >3000mg/L

Very high (shield) when in association with other conditions listed https://b-s-h.org.uk/media/18201/statement-from-the-haemoglobinopathy-co.pdf
Leukaemia – see blood cancer above It is not known whether COVID-19 affects patients with leukaemia, lymphoma or myeloma in different ways.
Lymphoma – see blood cancer above
Mannose binding lectin deficiency Low/Standard https://www.ukpin.org.uk/docs/default-source/default-document-library/ukpin_risk_stratification_covid19_finalac6baa9cd4eb6fe9b40eff00005026c1.pdf
Mast Cell Activation Syndrome Low/Standard

but may be increased, high or very high depending on underlying medical conditions and immunosuppression

https://ukmasto.org/covid-19-2020-03-27/
Myeloma – see blood cancer above
Myeloproliferative neoplasms

Taking

Anagrelide

Busulfan

Hydroxycarbamide

Interferon

or other medications to control blood count

Possibly increased https://www.mpnvoice.org.uk/coronavirus-covid-19-advice-and-information/coronavirus_covid_19_advice_for_people_with_mpns.aspx

There is currently no clear evidence for increased risk.

Myeloproliferative neoplasms

on aspirin alone or blood thinning tablets (Apixaban, Rivaroxaban, Warfarin etc.)

Low https://www.mpnvoice.org.uk/coronavirus-covid-19-advice-and-information/coronavirus_covid_19_advice_for_people_with_mpns.aspx

There is currently no evidence for increaed risk compared with the general population.

Pernicious anaemia Low

Provided adequate B12 levels are maintained

https://pernicious-anaemia-society.org/other-news/coronavirus-and-pernicious-anaemia/
Primary antibody deficiency

normal lungs not requiring
immunoglobulin treatment or
prophylactic antibiotics

Low

 

https://www.ukpin.org.uk/docs/default-source/default-document-library/ukpin_risk_stratification_covid19_finalac6baa9cd4eb6fe9b40eff00005026c1.pdf
Sickle cell disease (homozygous, HbSS, HbSBthal, HbSC etc.) Very high (shield) https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19

https://b-s-h.org.uk/media/18201/statement-from-the-haemoglobinopathy-co.pdf

Sickle cell trait Low/Standard
Splenectomy Increased/moderate or low/standard

Splenectomy has now been added to the NHSE shielding list. It is unclear why, unless accompanied by other significant factors.

https://www.hematology.org/covid-19/covid-19-and-itp

https://b-s-h.org.uk/media/18292/covid19-bsh-guidance-on-splenectomy-v2-final-6-may2020_.pdf

Based on knowledge of the immunological functions of the spleen, there is no evidence that the lack of a spleen or part of a spleen or a non -functioning spleen on its own renders patients at higher risk of Covid-19. Recommendations for shielding will therefore depend in the underlying cause for splenectomy or asplenia and any associated comorbidities and treatments.

However, viral infections can be complicated by bacterial superinfections, therefore severe sepsis could develop quickly. Splenectomised patients should have been immunised with appropriate vaccines to reduce this risk.

Thos who don’t require shielding have:

• Splenectomy for trauma
• Thalassaemia or other inherited red cell disorders with splenectomy but without significant iron overload or comorbidities
• Splenectomy for autoimmune disorders but not currently taking immunosuppressive treatment and not on SPL due to underlying disease.

Thalassaemia and

Iron overload (see above) or those with splenectomy in combination with another risk factor such as diabetes

Very high (shield) https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19

https://b-s-h.org.uk/media/18201/statement-from-the-haemoglobinopathy-co.pdf

Thalassaemia without complications Increased/moderate or low/standard https://www.hematology.org/covid-19/covid-19-and-thalassemia

Little is known, but a small cohort of Italian patients demonstrated relatively mild to moderate COVID-19 disease and the number infected was lower than expected.

Thrombosis, DVT or PE Low/standard

(may be high if PE affects lung function)

https://thrombosisuk.org/news/post.php?s=2020-03-20-blood-clots-thrombosis-and-covid-19

having blood clots such as DVT or PE is not associated with an increased risk of acquiring COVID-19

Von Willebrand disease Low/Standard https://haemophilia.org.uk/2020/03/17/updated-coronavirus-information/

https://www.hemophilia.org/Newsroom/NHF-Community-News/Health-and-Wellness-Update-5-from-Dr-Valentino

RELATED CONTENT

Vulnerability levels

Very high (Red)

Risk of severe illness or death if contracts COVID-19. Read more

High (Orange)

Likely to need hospitalisation if contracts COVID-19, with protracted illness and heavy NHS burden. Read more

Increased/Moderate (Yellow)

Increased risk compared with healthy individual but should recover.

Low/Standard (Green)

No greater risk than healthy individual.