COVID-19 proves an unprecedented challenge
At the Haematology conference, Medlab Middle East put the spotlight on the latest updates and diagnostic tools in the field.
Over the last year and a half, the pandemic has shown a remarkable rise in thrombosis (blood clots blocking blood vessels) in relation to the COVID-19 infection. It raised many questions about anticoagulation treatment indications within and outside the hospital.
Some countries were using aspirin to reduce the risk of thrombosis, while some others were using oral anticoagulants, which was causing a bleeding accident due to overuse.
Dr Kayane Mheidly, Consultant Haematology, Clemenceau Medical Center, Dubai, UAE, discussed the risk factor of thrombosis with COVID-19. She shed light on the physiopathology of thrombosis, how it can be prevented, and which patients require anticoagulation. "Haematological manifestations of the COVID-19 infection are various. The most frequent are thrombocytopenia and lymphopenia. There were also cases of aplastic anaemia and activation of macrophages caused by COVID.”
Dr Mheidly explained that the risk factor of thrombosis increases with age, inflammation for a patient with malignancies, post-surgery, with reduced mobility, pregnancy, use of oral contraception, hormonal replacements, history of thrombosis in the family.
The most frequent type of thrombosis is deep vein thrombosis (DVT) and pulmonary embolism. The other types of thrombosis are rare such as splanchnic vein thrombosis (SVT) and cerebral veins thrombosis.
Monitoring of haematological parameters such as the absolute lymphocyte count, neutrophil-to-lymphocyte ratio and D-dimers can offer prognostic insight in the management of COVID-19 and will help with early identification of high-risk patient groups.
She said that blood donors have become quite rare due to the pandemic as people are afraid to go to the hospital and give blood. However, some COVID-19 patients have anaemia and thrombocytopenia, which has increased the need for blood transfusions.
Dr May Raouf, Head of Dubai Blood Donation Center, DHA, UAE, and WHO expert member for Transfusion Safety, ISBT Regional Director for East Mediterranean Region, highlighted that blood transfusion is an important part of health services and is lifesaving in many conditions. SARS-CoV-2 has been an unprecedented challenge in many parts of the medical field with blood banking being no exception.
“Blood services must be prepared to move quickly in response to changes in the pandemic situation. A national approach, rather than a sub-national or local approach, should be adopted for coherence and coordination, but taking into account any specific localised factors or needs,” she stressed.
The availability of a comprehensive and well-structured business continuity plan is an important part of facility planning to act during such a pandemic.
To ensure donors safety during donation and staff safety in keeping social distance, blood services have adopted many measures such as giving appointments for donors to avoid crowds, extending or changing working hours, and in case their existing space for collection was small then finding temporarily bigger halls to carry out blood collection.
Placing thermal cameras to check employee and donors body temperature at entry point to blood centre, frequent cleaning, social distancing in seating the donors and, of course, the usage of personal protective equipment as required by local health authorities is also needed.
Ensuring the availability of the required number of donors was a big challenge that has been well managed in blood centres that have an updated data base for blood donors, including their contact telephone or emails.
Contacting the donors by telephones, SMS, emails or calling public through social media posts has played a very important role in keeping the flow of blood donors to visit the blood centres.
When it comes to quality considerations in haematology, Dr Han emphasised: “I believe that CAP provides the gold standard when it comes to the lab-quality framework.
Participation in external quality assurance, having quality indicators that cover all the phases of lab testing is the starting point for lab quality. Also, having a critical mass of regional pathology leaders who care about quality makes this journey easier as we share best practices.”