Public health

6 changes in haematology care suggested for COVID-19 disruption

Ahead of official guidance on how to reduce risks for haematology patient in the COVID-19 pandemic, haematologists at Oxford University  Hospitals NHS Trust in the UK say haematologists must plan for a worst case scenario.

In the British Journal of Haematology they offer several suggestions on how to reduce patient exposure to COVID‐19 infection and its complications, and also how to anticipate situations where healthcare services are critically stretched.

“There is great uncertainty surrounding the burden that managing COVID‐19 will place on global healthcare systems. It is prudent to plan for a scenario of maximal disruption, and consider how this would affect haematology patients, and the departments managing them, in the hope that many of the measures outlined may not need to be implemented,” they write

Their suggestions include:

1. Phlebotomy in car parks

To avoid clustering of large groups of vulnerable patients, establish off‐site phlebotomy facilities where patients can queue within their cars. And consider extending the interval between monitoring blood tests.

2. Defer maintenance chemotherapy

Maintenance and non‐curative chemotherapy could be paused if the immunosuppressive risks outweigh the benefits of treatment, for example maintenance rituximab in follicular and mantle cell lymphoma. Offer oral chemotherapy where possible to avoid unnecessary hospital visits.

3. Prioritise curative chemotherapy

In the worst‐case scenario, only immediately life‐saving chemotherapy may be considered if COVID-19 leads to shortage of staff such as chemo specialist nurses.

4. Pause supportive treatments such as venesection

It may be possible to pause the hospital-based provisions of therapies aimed at minimising longer term side‐effects. These may include venesection to reduce iron burden, and use of bisphosphonates to reduce bone effects in patients with myeloma.

5. Replace outpatient clinics with video or solo consultations

To avoid bringing potentially immunosuppressed patients into a crowded hospital environment, move outpatient clinics to telehealth appointments. Patients who attend in person should wait in their car until the clinician is available to see them, to avoid exposure to other patients.

6. Defer or transfer BMT patients

The prolonged immunosuppression, close follow‐up and demands on hospital services needed for bone marrow transplants may be hard to justify for hospitals hit by widespread COVID-19 caseload. It may be necessary to defer or ration transplants, or arrange for patients to be transferred to other areas with sufficient capacity.

The full recommendations can be accessed here.

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