10 May 2021

We aim to provide members with both general and haematology specific up-to-date COVID-19 information. This advice is for healthcare professionals. Patients looking for further information on their condition are advised to speak to their healthcare providers, who are best placed to answer specific questions. Patients may also be able to get information from their patient support groups, some of them can be found listed here


Media Statement on syndrome of Thrombosis and Thrombocytopenia occurring after coronavirus vaccination

BSH has informed the UK haematological community about this complication and is working with the Expert Haematology Panel to issue regular updated guidance as to how to best investigate and manage this condition.

The Expert Haematology Panel comprises of specialists in immunohaematology haemostasis and thrombosis (or blood clotting and immune causes of reduced platelets), who hold daily meetings to support clinicians managing these patients and learn from new cases. They are in regular communication with the regulators, other UK medical and surgical societies, multidisciplinary groups and international haematology colleagues focussed on this condition.

The Expert Haematology Panel has been instrumental in describing this condition and its management and continues to work closely with PHE and regulatory authorities. BSH is working with the EHP to make sure the haematology community is kept up to date with the latest information on this syndrome.  We have received many requests from media for information and interviews and we have done our best to advise and inform wherever possible. However, all our members have responsibilities as NHS clinicians which are their priority roles.  We will therefore be unable to respond to further media requests and if additional information is required please contact the MHRA.


This page will be reviewed every day and updated as necessary. If you would like to add any resources please contact: Saskia@b-s-h.org.uk

 

Guidance produced by the Expert Haematology Panel (EHP) focussed on Vaccine induced Thrombosis and Thrombocytopenia (VITT) (last updated 20/04/2021)

An expert team of our peers have recently been involved in diagnosing and managing a rare syndrome of thrombosis associated with low platelets which occurs after Astra Zeneca vaccine.

The thrombosis is rapidly progressive and there is a high preponderance of cerebral venous sinus thrombosis. Arterial thrombotic events have also been noted. Testing typically reveals low fibrinogen and very raised D-Dimer levels above the level typically expected in venous thromboembolism. Antibodies to platelet factor 4 (PF4) have been identified, hence there are similarities to heparin-induced thrombocytopenia despite the absence of prior exposure to heparin treatment. The anti PF4 antibodies can be detected by the ELISA HIT assay but not usually with other HITT assays.

It is important that the correct management is applied to prevent the progression of thrombosis. Of critical note, intravenous immunoglobulin should be given immediately and platelet transfusions avoided.

This is an immune condition and there is no evidence that individuals with a prior history of thrombosis or known risk factors for thrombosis are more at risk. For the majority of individuals, the risk of recurrent thrombosis due to Covid-19 infection is greater than the risk of this syndrome.

Please read this link for the latest Guidance produced by the Expert Haematology Panel (EHP) focussed on VITT, contact details for advice from the Expert Haematology Panel are included in the document, as well as links to report your case.

As this is an emerging area of practice, please continue to check back for updates and to monitor the literature for publications.


Media Statement on syndrome of Thrombosis and Thrombocytopenia occurring after coronavirus vaccination

BSH has informed the UK haematological community about this complication and is working with the Expert Haematology Panel to issue regular updated guidance as to how to best investigate and manage this condition.

The Expert Haematology Panel comprises of specialists in immunohaematology haemostasis and thrombosis (or blood clotting and immune causes of reduced platelets), who hold daily meetings to support clinicians managing these patients and learn from new cases. They are in regular communication with the regulators, other UK medical and surgical societies, multidisciplinary groups and international haematology colleagues focussed on this condition.

The Expert Haematology Panel has been instrumental in describing this condition and its management and continues to work closely with PHE and regulatory authorities. BSH is working with the EHP to make sure the haematology community is kept up to date with the latest information on this syndrome.  We have received many requests from media for information and interviews and we have done our best to advise and inform wherever possible. However, all our members have responsibilities as NHS clinicians which are their priority roles.  We will therefore be unable to respond to further media requests and if additional information is required please contact the MHRA.

Haematology triage policy for patients with previous vaccine-induced immune thrombocytopenia and thrombosis (VITT) (added 24/04/2021)

VITT is a rare disorder occurring after COVID-19 vaccination and leading to blood clots in multiple organ sites including the venous sinuses of the brain. Untreated the risk of death is over 50%. People who have previously had VITT may present with recurrent symptoms. They need to be monitored closely.

This document outlines the Haematology triage policy for patients with previous vaccine-induced immune thrombocytopenia and thrombosis (VITT) 

List of UK Laboratories Offering HIT ELISA testing added 24/04/2021

A list of UK Laboratories Offering HIT ELISA testing can be found here.

COVID-19 vaccine immune thrombosis and thrombocytopenia VITT Information for patients added 24/04/2021

This is a leaflet that can be printed out and given to patients.

Letter from BSH to The Joint Committee on Vaccination and Immunisation 08/01/2021

Letter from BSH to The Joint Committee on Vaccination and Immunisation sent 8 January 2021

Letter to MHRA from The Expert Haematology Panel endorsed by Thrombosis UK 09/04/2021
BSH statement relating to Haematology Healthcare Professionals and COVID-19/ SARS-CoV-2 Vaccination Dose Scheduling Changes 08/01/2021

BSH statement relating to Haematology Healthcare Professionals and COVID-19/ SARS-CoV-2 Vaccination Dose Scheduling Changes sent to The Joint Committee on Vaccination and Immunisation on 8 January 2021

COVID-19 vaccine in patients with haematological disorders (Last updated 13/01/2021)

COVID-19 vaccine in patients with haematological disorders

British Society for Haematology

This statement has been produced by the British Society for Haematology and has been reviewed by the Intercollegiate Committee on Haematology, on behalf of the Royal College of Physicians of London and the Royal College of Pathologists. Specialist haematology groups have also contributed.

 

General Haematology
Aplastic Anaemia Guidance (Last Updated 03/04/2020)

King’s College Hospital has released guidance for treating adult aplastic anaemia/bone marrow failure patients during the COVID-19 outbreak.

Click here to read the guidance.


 King's College Hospital has also created a brief data questionnaire for any AA patient in the UK who develops the COVID-19 infection. It is important to capture data in a systematic way on all aplastic anaemia(AA) patients with COVID-19 so that we can learn about the true impact of this virus in this group of patients.

Click here to download this questionnaire

BJHaem Articles (Last Updated 17/03/2020)

The BJHaem have published open-access articles about COVID-19.

Click the links below to read these articles

Care of haematology patients in a COVID‐19 epidemic

How do we plan hematopoietic cell transplant and cellular therapy with the looming COVID‐19 threat?

BSH Advice on B12 Supplements (Last updated 01/05/2020)

This is the BSH guidance on B12 supplements during COVID pandemic.

Read the guidance here 

Diamond Blackfan Anaemia Advice (Last Updated: 04/06/2020)

These documents were made in a collaboration between the Haemoglobinopathy Co-ordinating Centres in England, offering guidance to health professionals working with patients with Diamond Blackfan anaemia (DBA). It has been reviewed and agreed by representatives of the Haemoglobinopathy Co-ordinating Centres in England and the Clinical Reference Group for Haemoglobin disorders and DBA(UK). 

Click the links below to download advice:

NHP COVID-19 Guidance (PDF version)

NHP COVID-19 Guidance: Patients Version (PDF version)

 

Gaucher Disease and COVID-19 Infection (Last Updated 04/05/2020)

The European Gaucher Disease Network, an EHA SWG GD Task Force, have written a response to the current SARS-­‐CoV2 (COVID-19) infection.

Click here to read this response 

Guidance on management of ITP (Last Updated 11/01/2021)

The UK ITP Forum, has provided information for adult patients with immune thrombocytopenia in the setting of COVID-19.

Click here to read the document


Practical guidance has been developed for the management of adults with Immune Thrombocytopenia during the COVID-19 pandemic.

Click here to read this guidance.

NICE COVID-19 guidelines (Last Updated 23/03/2020)

NICE new guidelines cover the management of patients in critical care, the management of patients who are having kidney dialysis and the management of patients who are receiving systemic anticancer treatments.

It should be noted that due to the need to publish these very rapidly they have not gone through the usual NICE guidance development process.

Plasmacytoid lymphocytes in COVID-19 (Last updated 30/04/2020)

This is a morphology update article, about a recent case of Plasmacytoid lymphocytes in a patient with COVID-19. It was written by Barbara J. Bain, David Foldes, Richard Hinton and Siamak Arami.

Click here to read this article 

Guidance on shielding for Children and Adults with splenectomy or splenic dysfunction during the COVID-19 pandemic (Last updated 06/05/2020

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

Please see our guidance here

Reprovisioning Haematology - Last Updated 31/07/2020

Along with many other Specialist Societies, BSH has been working with the Royal College of Physicians to highlight the issues of re-provisioning services in the presence of an ongoing COVID-19 risk.

The following brief summary document has been submitted to RCP and used to inform discussions at a senior level in the Department of Health.

Reprovisioning Haemtology Document 

Sickle cell and Thalassaemia
Haemoglobinopathy Co-ordinating Centres Advice on COVID-19 in patients with Sickle Cell Disease and Thalassaemia (Last Updated 20/04/2020)

A statement has been released from the Haemoglobinopathy Co-ordinating Centres.

Please read the statement here

Iron Chelation Therapy (Last Updated 15/04/2020)

Guidance regarding iron chelation therapy in patients haemoglobin disorders or rare anaemias and cardiac iron overload if unwell with presumed or confirmed COVID-19 infection.

Read the guidance here

Patient information on COVID-19 in haemoglobinopathy and rare inherited anaemia patients (last updated 18/06/2020)

National Haemoglobinopathy Panel Patient information on COVID-19 in haemoglobinopathy and rare inherited anaemia patients is here.

Transfusion needs of patients with inherited red cell disorders (Last Updated 15/04/2020)

Guidance on supporting the transfusion needs of patients with inherited red cell disorders during the COVID-19 pandemic in England.

Read this guidance here 

Haemoglobinopathy HCCs advice on recovery COVID-19 26.06.2020

Advice to clinicians on planning for recovery from COVID-19.

This information has been produced following virtual meetings with representatives from the Haemoglobinopathy Co-ordinating Centres (HCCs) for Haemoglobin Disorders, the Clinical Reference Group for Haemoglobin Disorders, the National Haemoglobinopathy Panel, NHS Screening Committee and NHSBT as well as national experts on Sickle Cell Disease, Thalassaemia and Rare Anaemias and patient groups. The topics covered include: 1. Updated shielding advice 2. General advice 3. Inpatient care 4. Day care management 5. Outpatient care and care of long term complications 6. Hydroxycarbamide 7. Annual Reviews 8. Trans-cranial Doppler (TCD) screening 9. Multi-specialist clinics 10. Off-site clinics 11. Management of iron overload 12. Multi-disciplinary meetings 13. Transition 14. Psychology support 15. Community services 16. Education 17. Research 18. Additional advice on management of thalassaemia and rare anaemias 19. Management of patients who have had a Haematopoetic Stem Cell Transplantation /Gene therap

Advice to clinicians on risk assessment for severe COVID-19 in patients with haemoglobinopathies and inherited rare anaemias (last updated 28.08.2020
Haemato-Oncology
Blood Cancer UK: resources for healthcare professionals working in haemato-oncology (Last Updated: 22/05/2020)

Blood Cancer UK's brand NEW webpages for all healthcare professionals working in haemato-oncology are now live.

 

Topics include:

  

EHA/ESMO Clinical Practice Guidelines for the Management of Malignant Lymphoma: Recommendations for the Second Phase of the COVID-19 Pandemic (Last updated 08/02/21)

EHA/ESMO Clinical Practice Guidelines for the Management of Malignant Lymphoma: Recommendations for the Second Phase of the COVID-19 Pandemic

Previously, the European Society of Medical Oncology (ESMO) had established cancer patient management during the coronavirus disease 2019 (COVID-19) pandemic.1 These recommendations should be used as guidance for prioritizing the various aspects of cancer care in order to mitigate the negative effects of the COVID-19 pandemic on the management of cancer patients.

BSBMTCT Recommendations (Last Updated: 18/03/2020)

The British Society of Blood and Marrow Transplantation and Cellular Therapy(BSBMTCT) have created recommendations for adult patients with COVID-19.

Click here to read the recommendations

Chronic Myeloid Leukaemia (Last Updated 23/03/2020)

The National Cancer Research Institute (NCRI) has created COVID-19 (coronavirus) advice for patients with Chronic Myeloid Leukaemia receiving TKI therapy.

Please click here to read this advice

EBMT Recommendations (Last Updated: 18/03/2020)

The European Society for Blood and Marrow Transplantation (EBMT) have issued recommendations for recipients and donors of hematopoietic cells before the beginning of any of the transplant procedures (mobilization, apheresis, marrow harvest, conditioning). These guidelines will be updated when new information is obtained about COVID-19 epidemiology and clinical outcome.

Click here to read current guidelines

To read more from the EBMT, please click link below: 

https://www.ebmt.org/ebmt/news/coronavirus-disease-covid-19-ebmt-recommendations-update-march-16-2020

Myeloproliferative Neoplasms Advice (Last updated 30th March 2020)

MPN Voice provides information and emotional support to everyone who has been diagnosed with a myeloproliferative neoplasm (MPN) and their families.  Therefore, like many other organizations during the COVID-19 outbreak, MPN Voice are providing people with information issued by the NHS and the Government. 

Click here to read this advice

NICE guideline COVID-19 rapid guideline: haematopoietic stem cell transplantation Published on 01 April 2020
UK/Ireland Paed BMT group guidelines (Last updated 23/03/2020)

The UK/Ireland Paediatric BMT group has created practical guidelines for the prevention and management of COVID-19 in paediatric HSCT patients. 

Please note: These guidelines are purely advisory and should be implemented in the context of advice from Dept of Health, your Trust management and Infection Control teams and will evolve as the situation changes.

Click here to read the guidelines. 

UK Myeloma Forum (Last Updated 27/03/2020)

The UK Myeloma Forum has released guidance on treating patients in the current COVID-19 pandemic.

Click here to read this guidance.

UK Chemotherapy Board Clinician Frequently Asked Questions (FAQs) and guidance on COVID19 vaccine for patients receiving Systemic Anti-Cancer Therapy (Added 12/01/2021)

This document has been produced in response to questions raised by cancer health care professionals relating to the administration of the Pfizer/BioNTech COVID-19 vaccine and the Oxford University/AstraZeneca COVID-19 vaccine in patients receiving SACT.

Transfusion
BSBMTCT Recommendations (Last Updated: 18/03/2020)

The British Society of Blood and Marrow Transplantation and Cellular Therapy(BSBMTCT) have created recommendations for adult patients with COVID-19.

Click here to read the recommendations

EBMT Recommendations (Last Updated: 18/03/2020)

The European Society for Blood and Marrow Transplantation (EBMT) have issued recommendations for recipients and donors of hematopoietic cells before the beginning of any of the transplant procedures (mobilization, apheresis, marrow harvest, conditioning). These guidelines will be updated when new information is obtained about COVID-19 epidemiology and clinical outcome.

Click here to read current guidelines

To read more from the EBMT, please click link below: 

https://www.ebmt.org/ebmt/news/coronavirus-disease-covid-19-ebmt-recommendations-update-march-16-2020

COVID-19 UK Convalescent Plasma trials (Last Updated 28/04/20)

The NHS is now leading a major new programme, on behalf of the Government, to collect convalescent plasma from people who have recovered from COVID-19.

Click the links below to read more about this:

https://www.nhsbt.nhs.uk/covid-19-research/documents-and-downloads/

 

https://hospital.blood.co.uk/​  (click on convalescent plasma tab)

 

General Transfusion advice (Last updated 25/03/2020)

During the COVID-19 pandemic, it is important, that patients are able to still receive blood transfusions if and when needs be. This link contains information on current blood and platelets stocks and also other key resources from NHS Blood and Transplant and the National Blood Transfusion Committee included Emergency Blood shortage plans for hospitals.

Please click the link below to access the information:

https://hospital.blood.co.uk/business-continuity/coronavirus-covid-19/


Other Transfusion Resources:

https://www.transfusionguidelines.org/

https://hospital.blood.co.uk/business-continuity/coronavirus-covid-19/

Haemostasis and Thrombosis
INR testing for out-patients on warfarin (Last updated 24/03/2020)

The BSH Haemostasis and Thrombosis Task Force has created guidance on INR testing for out-patients on warfarin during COVID-19 restrictions.

Click here to read this guidance

Warfarin and other anticoagulants – monitoring of patients during the COVID-19 pandemic (added 16.10.2020)

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

 

The MHRA has published advice for patients and healthcare professionals