Last updated 1 Jun 2020
Author: Dr Tony Williams, Consultant Occupational Physician, Working Fit Ltd
|Allogenic transplant (using donor stem cells) in the last two years||Very high risk (shield)
|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 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
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|
Diagnosed 1-4.9 years ago
|Add 13 years||This is provisional and may change|
Diagnosed ≥5 years ago
|Add 7 years||This is provisional and may change|
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|
|Diamond Blackfan anaemia
without complications listed above
|Very high risk
Social distancing and
work from home even if key worker
unless other complications or co-morbidities
isolated, with no other immunodeficiency
|Immune thrombocytopaenia and treatment with
Rituximab in past 12 months
|Very high or high||https://b-s-h.org.uk/media/18202/information-for-patients-with-itp-regarding-coronavirus-corvid19-23-3-20.pdf|
Including treatment with
As these will not affect the immune system.
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
|Myeloma – see blood cancer above|
or other medications to control blood count
There is currently no clear evidence for increased risk.
on aspirin alone or blood thinning tablets (Apixaban, Rivaroxaban, Warfarin etc.)
There is currently no evidence for increaed risk compared with the general population.
Provided adequate B12 levels are maintained
|Primary antibody deficiency
normal lungs not requiring
|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|
|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.
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
Iron overload (see above) or those with splenectomy in combination with another risk factor such as diabetes
|Very high (shield)|
|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)
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/|
Risk of severe illness or death if contracts COVID-19. Read more
Likely to need hospitalisation if contracts COVID-19, with protracted illness and heavy NHS burden. Read more
Increased risk compared with healthy individual but should recover.
No greater risk than healthy individual.