Impact of Covid-19 on Hematological Practice: Challenges and Opportunities
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EDITORIAL
Impact of Covid-19 on Hematological Practice: Challenges and Opportunities Rajat Kumar1
Published online: 12 October 2020 Ó Indian Society of Hematology and Blood Transfusion 2020
As on Sept 27, 2020, the total number of coronavirus disease 2019 (Covid-19) cases crossed 32 million, with India ranking second highest at almost 6 million and global deaths predicted to cross 1 million, as per WHO [1]. This pandemic has posed a major challenge to hematology patients who often need specialized management. As we face these problems, the crisis also offers opportunities for improving patient care, research and education.
Challenges Patients with hematological malignancies are often neutropenic, immunocompromised, and receiving chemotherapy. Results from New York demonstrate that mortality was higher in patients with cancer, especially hematological malignancies, than in other patients [2]. Those with non-malignant disorders, like aplastic anemia or immune thrombocytopenia, are often also on immunosuppressive drugs and conceivably at higher risk. Due to the pandemic, severe disruptions have occurred to hematology services, compromising the care of patients with severe forms of thalassemia, sickle cells disease and hemophilia— who are dependent on regular blood component therapy and specialized supportive care. Patients too often delay seeking medical attention, presenting with advanced disease.
& Rajat Kumar [email protected] 1
Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, UHN, University of Toronto, 610 University Avenue, 700U: 6-525, Toronto, ON M5G 2M9, Canada
Within weeks of the pandemic being declared, professional societies rallied and issued guidelines based on evolving evidence and expert opinion. These are aimed at reducing spread of the virus and managing with limited facilities as these are prioritized to treat Covid-19 patients. One of the best resources is provided by the American Society of Hematology (ASH), and it links to updated information from many other organizations at https://www. hematology.org/covid-19. While most of these measures work well in high-income countries, these may not be practical in economically deprived regions. The recent prioritized approach by Jain et al. [3] is commendable as this presents an Indian context and even includes Ministry of Health and Family Welfare recommendations. Their review will be valuable to other countries with similar infrastructure limitations. There are other challenges faced by the hematology community worldwide. Voluntary blood donation has dropped due to fears of contracting the SARS-COv-2 in a health care facility. The blood component shortages provide an opportunity to use alternative measures like tranexamic acid to manage and prevent bleeding, erythropoiesis stimulating agents instead of red cell transfusions, and new triggers for platelet transfusions.The use of convalescent plasma from recovered patients of Covid-19 requires the services of transfusion medicine and apheresis teams with an impact on p
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