A review on how to do hematology consults during COVID-19 pandemic

Abstract

The ongoing COVID-19 pandemic is the most trending and talked topic across the World. From its point of origin in Wuhan, China to clinical laboratory at NIH, a mere six-month-old SARS-CoV-2 virus is keeping the clinicians, and scientists busy at various fronts. However, COVID-19 is an emerging and evolving disease and each day brings in more data, new figures, and findings from the field of clinical practice. The role of hematologists has been increasingly recognized during the current pandemic because of several reasons. Most important of them are the characteristic hematological findings of COVID-19 patients that also have prognostic implications and that were not seen in other viral infections. The treatment of hematological complications in COVID-19 patients is very challenging given the critical care setting. There are interim and limited guidelines thus far due to the novelty of the disease. As this remains to be a quite fluid situation, all the appropriate medical societies including the major hematology bodies are proposing initial and interim guidelines (e.g. ASH guideline). This puts a hematologist on consult service in a dubious position where, he/she must tailor the recommendations on case to case basis. The purpose of this review is to provide the background context about the impact of COVID-19 on the blood system and to summarize the current interim guidelines to manage the associated hematological issues in COVID-19 infection.

Keywords: COVID-19; Consultation; Coronavirus; Hematology; Pandemic.

Fig. 1

Approach to coagulopathy in a patient with COVID-19. Depending on clinical symptoms of bleeding (left section in red) vs no bleeding (right section in yellow), target value threshold for platelet count and coagulogram parameters are variable (adapted from ASH and ISTH). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)