Summary of COVID-19 medicines guidance: Haematological disorders

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

This page has been put together rapidly in relation to the COVID-19 pandemic.

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:

NHS England/NHS ImprovementClinical guide for the management of anticoagulant services during the coronavirus pandemic

Last updated: 31st March

  • NHS England has produced a clinical guide for the management of anticoagulant services during the coronavirus pandemic.
  • This includes information on which patients are suitable to be switched to DOACs and how this should be done.

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

Last updated: 14th July

  • 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.

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

Last updated: 1st May

A summary of this guidance is available on a separate page – Injectable medicines commonly used in primary care during COVID-19: Vitamin B12

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

Last updated: 1st April

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

Last updated: 15th July

  • The British Society of Haematology has issued advice to help keep patients with immune thrombocytopenia safe during the COVID-19 pandemic.

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

Last updated: 6th May

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

Thrombosis UK: Practical guidance for the prevention of thrombosis and management of coagulopathy and disseminated intravascular coagulation of patients infected with COVID-19

Last updated: 19th June

  • 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.

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

Last updated: 4th May

  • The British Thoracic Society has released guidance regarding thromboprophylaxis in severely ill patients with COVID-19.
  • There is evidence of increased prevalence of venous thromboembolic events in COVID-19, especially in patients with more severe disease.
  • Patients with a higher risk of VTE may benefit from an intermediate dose LMWH instead of a standard prophylactic dose. However due to the lack of evidence it is not possible to advocate any particular approach and it is suggested that local protocols for risk stratification in COVID-19 patients are developed.
  • Extended thromboprophylaxis can be considered on discharge for patients considered as high risk. The duration of thromboprophylaxis is not clear but a standard dose of LMWH or DOAC for 4 weeks may be considered.

Administration update (24th August 2020): administrative amendments made to the page only.