A group of PGIMER doctors and researchers had written a review article highlighting the prioritized method to treat hematological disorders during COVID-19 in India. The review article was recently published in the Indian Journal for Hematology and Blood Transfusion.

Dr Pankaj Malhotra of the Department of Internal Medicine, also one of the authors of the study, said that the idea for writing this treatment strategy was to offer a framework by which cancerous and other hematological disorders patients can receive the treatment they require, regardless of the limitations of the coronavirus pandemic and the subsequent lockdown.

The review article has stated that the country is overburdened by COVID-19, making patients with co-morbidities, especially cancer patients in an immunosuppressed state, more susceptible to a severe, life-threatening form of the infection. Hence, the review summarizes the probable challenges clinicians would possibly face, important considerations to guide decision-making and potential solutions to the anticipated decision-making. The article also offers disease specific recommendations on treating hematological disorders, keeping in mind the limitations of India’s public healthcare set up. Hematological disorders are referred to blood and blood forming organs related ailments, ranging from chronic non-cancerous conditions, i.e. hemophilia, to cancerous diseases, i.e. Hodgkin’s disease or leukemia.

The article quotes studies that have indicated the incidence of COVID-19 in cancer patients, which is at least two per cent and cancer patients have a 3.5 times more probability of acquiring the disease than other people. It highlights the necessity to strategize and organize for hematological treatment, especially in malignant conditions.

The article has also cited a retrospective study from three centers in China that had presented a mortality rate of 28.6 per cent in cancer patients who were admitted to these hospitals. The prevalent circumstances, in the middle of the pandemic, make it very important that cancer patients should receive timely intervention.

The researchers have distributed conditions and diseases into high priority, immediate priority and low priority categories, as per the healthcare authorities across the country can offer prioritized interventions with the available limited resources. Dr Malhotra explains that the most prioritized disease is the cancerous diseases and can be treated with curative therapy, as timely intervention can lead to having a longer and healthy life in these patients.

As per the article, induction therapy for acute leukemia, and chemotherapy for other acute cancerous diseases, i.e. lymphomas and myelomas, should be treated as high priority with immediate intervention. Besides this, ‘factor support for severe hemophilia with acute bleed’ and ‘anticoagulation for acute thrombosis’ should also be listed in prioritized diseases, for prompt intervention in hospitals and clinics across the country. Post-therapy surveillance in long-term survivors, such as post-transplant patients and haemophilia patients after elective surgery are placed in the low priority list by the researchers.

The researchers have also given detailed broad recommendations for haematologists who are working through the coronavirus pandemic, highlighting the requirement to maintain individual therapeutic care for all patients on a case-to-case basis. Doctors are advised to connect with local healthcare workers so that patients can receive the treatment immediately without requiring to travel far and exposing themselves to COVID-19. The review article also stated that while 70 percent of Indian population lives in rural pockets, 95 percent of cancer care is being provided in urban settings, making it impossible for safeguarding that all cancer patients will receive treatment locally with the existing system of healthcare in India. The researchers say that healthcare facilities might have to continue to provide cancer care via some strategic reorganization of resources.

The study has concluded that the review and recommendations are based on limited real-time data on the effect of the coronavirus pandemic on patients with haematological disorders in India. The researchers have trusted their “expertise” to combine the review study. Though, with more data and experience regarding treatment during the COVID-19 pandemic, guidelines can be modified and applied efficiently to different situations. The study says that physicians serving patients with hematologic disorders also need to review and implement the hurriedly evolving global, Indian and institute specific guidelines and adjust in a way that is suited best to their local situation.

Source: The Indian Express