Haematological disorders during corona times: listing the risks and consequences

April 2020 Corona Willem van Altena

Electron micrograph of Coronavirus, the cause of Severe Acute Respiratory Syndrome, SARS

The corona virus outbreak and the subsequent measures that have been put in force in Belgium affects everyone, not least of all people with a haemato-oncological condition. The danger that COVID-19 poses to the elderly and infirm –especially, but not only lung patients- is very apparent. The threat is threefold: people in these categories are more susceptible to infection, stand a greater chance of developing worse symptoms or even dying, and will recover at a much slower rate.

People with haemato-ocological illnesses are part of this vulnerable group, and there are four groups of patients that need to be even more vigilant in relation to the corona virus. These are:

1: People undergoing treatment for leukaemia, bone marrow cancer or lymph node cancer. Specifically those who are being treated medicinally with either tablets, injections or by intravenous drip. This includes people who are receiving maintenance treatment. People who are being treated with radiotherapy are not in the high-risk group.
2: People who underwent an allogeneic stem cell transplant within the last year (i.e. a stem cell transplant with stem cells from a donor). The corona virus poses an extra high risk to them, because their immune system has been dampened with chemotherapy and/or radiation in order to prevent a host-versus-graft response. This means these patients are extremely vulnerable to infections of all kind.
3: People who have received and autologous stem cell transplant (i.e. a stem cell transplant with someone’s own cells) within the last twelve months should also be aware of the risk COVID-19 poses. These patients have also been treated with immunosuppressants.
4: People who suffer from auto-immune diseases are also in the high-risk bracket, as are people who are being treated with certain types of medication such as prednisone.

Advice for haemato-oncology patients

The BHS has compiled an overview of special national and international guidelines concerning the treatment of haemato-oncological illnesses during the corona crisis. These can be found on a special website.

On the whole, it is recommended that people with haemato-oncological disorders follow the same advice as everyone else. Social distancing, avoiding crowds, sneezing and coughing into the elbow, frequent hand washing, no face touching, working from home… these practices have become the norm. Still, it is recommended that people with a haemato-oncological condition take extra precautions. For instance by extending the ‘social distance’ to two metres. But also to apply social distancing within the own home, even with members of your own family, especially if members of the household cannot work from home and are in contact with others.

If a household member falls ill, or shows symptoms such as coughing, a runny nose and/or raised temperatures, people are urged to seek medical advice and phone –not visit!- their G.P. immediately. Also, vulnerable people must try to avoid going outside and limit contact to other people as much as possible. Ask others to do the shopping or try and go at the quietest moments.

Should a haemato-oncological patient develop symptoms that could be related to COVID-19, it is imperative he or she seeks immediate medical advice by phoning the G.P. or the haematologist.

Haemophilia

People with haemophilia are in a less precarious position than oncology patients. The corona virus does not pose any significant extra risk to them. There has been some concern over the availability of clotting factors, but at the time of publication (mid April) there seems to be no shortage in production or supply. The Belgian haemophilia patient organization AHVH has issued a statement regarding the effects of the corona outbreak which can be found here.

Warning

An important warning for haemophiliacs, should COVID-19 symptoms occur: do not, under any circumstance take aspirin or NSAID’s such as ibuprofen. Only paracetamol is safe to use for haemophiliacs.