Summary of COVID-19 medicines guidance: Haematological disorders

Nancy Kane, Senior Medical Information Scientist, Regional Drug & Therapeutics CentrePublished Last updated See all updates

This page summarises and signposts to medicine related guidance we’re aware of from professional and government bodies relating to coronavirus and haematological disorders.

Our advice is constantly reviewed as the pandemic situation evolves.

Whilst we have tried to ensure that the information on this page is complete, please report a concern if you feel anything is omitted or inaccurate.

To see our professional guidance summaries for other clinical areas, click here

Advice in this area includes:

NICE: COVID-19 rapid guideline: managing COVID-19

Last updated: 10th August 2021

For young people and adults with COVID-19 that is being managed in hospital

  • Assess the risk of bleeding as soon as possible after admission or by the time of the first consultant review
  • Start VTE prophylaxis as soon as possible and within 14 hours of admission.
  • Consider a treatment dose of a low molecular weight heparin (LMWH), unless contraindicated.
  • Adjust the dose as necessary for patients with extremes of body weight, impaired renal function, or receiving high-flow oxygen, continuous positive airway pressure, non-invasive ventilation or invasive mechanical ventilation, or palliative care (see guidance for details)
  • Treatment should be for a minimum of 14 days or until discharge. Dose reduction may be needed to respond to any changes in a person’s clinical circumstances
  • For people who cannot LMWHs, use fondaparinux sodium or unfractionated heparin (UFH)
  • For people who are already having anticoagulation treatment for another condition when admitted to hospital:
    • continue their current treatment dose of anticoagulant unless contraindicated by a change in clinical circumstances
    • consider switching to a LMWH if their current anticoagulant is not an LMWH and their clinical condition is deteriorating.
  • If a person’s clinical condition changes, assess the risk of VTE, reassess bleeding risk and review VTE prophylaxis

For people with COVID-19 managed in hospital-led acute care in the community settings:

  • assess the risks of VTE and bleeding
  • consider pharmacological prophylaxis if the risk of VTE outweighs the risk of bleeding

For women with COVID-19 who are pregnant or have given birth within the past 6 weeks, follow the advice on VTE prevention in the Royal College of Obstetricians and Gynaecologists guidance on coronavirus (COVID-19) in pregnancy.

For children with COVID-19 admitted into hospital, follow the advice on COVID-19 guidance for management of children admitted to hospital in the Royal College of Paediatrics and Child Health guidance.

 

NHS England/NHS ImprovementEltrombopag as bridging therapy to haematopoietic stem cell transplant in severe or very severe aplastic anaemia during the COVID19 pandemic (in adults)

Last updated: 30th July 2021

  • Off-label use of eltrombopag can be given as a bridging therapy for patients with severe or very severe aplastic anaemia.
  • The aim of this treatment is to delay the need for haematopoietic stem cell transplant or immunosuppressive therapy with antithymocyte globulin as both these therapies require admission to hospital.
  • Patients can remain in their own home until haematopoietic stem cell transplant or immunosuppressive therapy with antithymocyte globulin can be safety undertaken.
  • Eltrombopag used as bridging therapy should be discontinued once haematopoietic stem cell transplant programmes have recovered following the COVID-19 pandemic.
  • The document will be updated prior to April 2022.

 

Department of Health and Social Care: Therapeutic Anticoagulation (Heparin) in the Management of Severe COVID-19 (SARS-CoV-2 Positive) Patients

Last updated: 23rd December 2020

  • Therapeutic dose of either unfractionated heparin (UFH) or subcutaneous low molecular weight heparin (LMWH) should not be offered in the treatment of patients with COVID-19, unless there is a standard indication for therapeutic anti-coagulation, such as the acute management of deep vein thromboses or pulmonary emboli, or as part of a clinical trial.
  • Continue to use pharmacological VTE prophylaxis in COVID-19 pneumonia, unless contraindicated, with a standard prophylactic dose (for acutely ill medical patients) of LMWH.
  • Clinical trials has reported that a therapeutic dose of heparin does not improve clinical outcome in the management of severe COVID-19 in the critical care setting, unless otherwise recommended for other indications.

 

MHRA: Warfarin and other anticoagulants – monitoring of patients during the COVID-19 pandemic

Last updated: 13th October 2020

  • There have been reports to the MHRA of increased numbers of patients with elevated INR values during the COVID-19 pandemic. The cause of this could be multifactorial.
  • Healthcare professionals are reminded that acute illness may exaggerate the effect of warfarin tablets and necessitate a dose reduction. Therefore, continued INR monitoring is important in patients taking warfarin or other vitamin K antagonists (VKA) if they have suspected or confirmed COVID-19 infection.
  • Healthcare professionals are therefore reminded of the potential for drug-drug interactions between oral anticoagulants and certain antibiotics and antivirals that may be used in the treatment of COVID-19. This includes advice on the need for INR monitoring in patients taking VKA who have recently started taking new medications.
  • There have been a small number of patients in whom warfarin treatment was continued after starting treatment with DOACs. To reduce the risk of over-anticoagulation and bleeding, healthcare professionals should ensure that warfarin treatment is stopped before DOACs are started.

 

British Society for Haematology: BSH guidance on B12 supplements during COVID pandemic

Last updated: 1st May 2020

The guidance offers brief advice for patients with dietary and non-dietary vitamin B12 deficiency, including:

  • Recommended precautions for patients attending GP surgeries
  • Oral cyanocobalamin
  • Resuming IM injections

 

British Society for Haematology: Guidance for adult aplastic anaemia/bone marrow failure patients during the COVID-19 outbreak

Last updated: 1st April 2020

  • Patients with aplastic anaemia (AA) treated with immunosuppressive drugs, notably antithymocyte globulin (ATG) and ciclosporin are high risk for developing COVID-19.
  • Patients on ciclosporin should not suddenly stop the drug as there is a risk of relapse of the AA. Blood monitoring of ciclosporin levels could be reduced/temporarily stopped in those patients with normal renal and liver function and well controlled/absent hypertension.
  • Newly diagnosed patients with severe disease/cytopenias should receive treatment with ATG. For less severe disease, patients may be considered for single agent oral ciclosporin.
  • Corticosteroids should not be given to treat AA, other than as needed with ATG to prevent serum sickness.

 

British Society for Haematology: Information for adult patients with immune thrombocytopenia in the setting of COVID-19 pandemic

Last updated: 4th January 2021

The British Society of Haematology has issued practical guidance for the assessment and management of patients with Immune Thrombocytopenia (ITP) during the COVID-19 pandemic. It covers:

  • Management of new/relapsed ITP, including advice on intravenous Immunoglobulin, tranexamic acid, immunosuppressant drugs, and platelet transfusions
  • Management of chronic ITP

 

British Society for Haematology: Guidance on shielding for Children and Adults with splenectomy or splenic dysfunction during the COVID-19 pandemic

Last updated: 6th May 2020

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. However all patients with splenectomy or splenic dysfunction should follow the recommendations below:

  • Patients should ensure they are up to date with their vaccinations.
  • Patients taking regular prophylactic antibiotics should be encouraged to continue.
  • Those who are not taking antibiotics should have a supply at home to take if unwell and instructed to do so by a clinician.
  • All patients reporting a new fever should be evaluated for bacterial as well as viral infection

 

British Society for Haematology: COVID-19 vaccine in patients with haematological disorders

Last updated: 13th January 2021

Advice on COVID-19 vaccine in patients with haematological disorders. The following groups are discussed:

  • Patients with bleeding disorders
  • Patients of anticoagulation or anti-platelet therapy
  • Auto-immune haematological conditions on immunosuppression
  • Patients with Haemoglobinopathies and Rare Inherited Anaemias
  • Haematopoietic stem cell transplantation (HSCT)
  • Lymphoma
  • Chronic Lymphocytic Leukaemia
  • Multiple Myeloma
  • Myelodysplasia
  • Myeloproliferative disorders
  • Aplastic Anaemia

 

British Thoracic Society: Guidance on Venous Thromboembolic Disease in patients with COVID-19

Last updated: 8th Feb 2021

The British Thoracic Society has published guidance regarding thromboprophylaxis in severely ill patients with COVID-19.

  • The risk of thrombosis and VTE is increased in patients with COVID-19; those with clinically severe disease requiring Critical Care (ICU/HDU) are at highest risk.
  • All patients admitted with COVID-19 should be assessed for, and the majority receive, thromboprophylaxis.
  • The optimal regimen for thromboprophylaxis is unclear. Currently we continue to suggest prophylactic dose low molecular weight heparin (LMWH) for patients managed on a ward and consideration of intermediate dose LMWH for patients on critical care. These recommendations may change following fuller publication of recent interim data suggesting benefit of therapeutic anticoagulation in moderately ill patients, but not in severely ill patients requiring critical care.
  • Prophylactic thromboprophylaxis for up to 4 weeks may be considered for patients discharged following COVID-19 pneumonia who are deemed to be at high risk of VTE and low risk of bleeding

 

Thrombosis UK: Clinical guide for the prevention, detection and management of thromboembolic disease in patients with COVID-19

Last updated: 19th June 2020

  • Standard prophylactic dose low molecular weight heparin (LMWH) is recommended for COVID-19 patients requiring ward-based care.
  • Patients already on anticoagulation with a vitamin K antagonist or direct oral anticoagulant (DOAC) can either continue with current anticoagulation or switch to LMWH.
  • Patients in  a high dependency unit or critical care unit should receive higher doses of LMWH as patients with severe COVID-19 appear to have an increased incidence of VTE. These should be balanced with the individual patient’s bleeding risk.
  • An intermediate dose of LMWH – increasing prophylactic dosing to twice daily or a larger dose once daily – should be considered.

Change history

  1. Minor administrative amendments only
  1. Resources checked and information remains correct
  1. Minor administrative amendments only
  1. Minor administrative amendments only
  1. Published