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COVID-19 update for patients with ITP and those on immunosuppressive medication (medications that affect your immune system)

COVID-19 is a viral infection caused by a newly emerged form of coronavirus particularly affecting the upper airways and lungs. Everyone in the population needs to be vigilant about minimising the risk of infection, monitoring for signs of infection and reducing risk of transmitting the infection to others. We are aware however that our Haematology patients may have particular concerns and needs.

The Haematology team here at St George’s Hospital are here to support you during this difficult and anxiety provoking time.  Whilst it will be necessary to make some changes to the way we deliver care, we will be doing our best to continue your Haematology care as far as possible during the coming weeks to months.  We are also here along with the rest of the hospital a to manage and support you if you have concerns related to COVID-19 and your blood disorder.

Sources of Information for patients with ITP particularly those on medications that affect their immune system

Immune thrombocytopenia (ITP) is not considered a ‘serious’ health condition in the situation of the current COVID-19 pandemic. However, we are sure you and your families are concerned about the risk of coronavirus infection at this time and want to provide some guidance on what you should do as a person who has ITP.

The large majority of people who contract coronavirus can stay at home to recover and do not need to seek medical advice unless their symptoms worsen.

It is also worth remembering that, like any viral infection, the coronavirus infection might trigger an episode of ITP.

Some of the treatments used for ITP will affect your immune system and may reduce your ability to fight the infection. These treatments include:

  • Prednisolone or dexamethasone (steroids)
  • Mycophenolate Mofetil (Cellsept)
  • Azathioprine
  • Cyclosporine
  • Vincristine
  • Rituximab (given in the past 12 months)
  • Splenectomy (patients are advised to be diligent with their antibiotic prophylaxis and be up-to-date with their vaccination schedule)

Neither Romiplostim (N-Plate) nor Eltrombopag (Revolade) will affect the immune system and risk will depend on other treatments being received at the same time or in the recent past.

There is up to date advice on the ITP patient support association website https://www.itpsupport.org.uk/index.php/en/news/coronavirus-covid-19-news/171-coronavirus-covid-19-updated-information-statement-from-the-itp-forum-itp-support-association-23rd-march-2020

Please see here for the most up to date letter with information for patients with immune thrombocytopenia (ITP) and COVID-19 here.

Shielding and isolation advice

Government guidelines were updated on Monday 23rd March to suggest that some patients should consider ‘shielding’ for 12 weeks depending on the medication regimen they are on – all details can be found on this letter and further details describing and explaining shielding can be found here https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19

Attached here is a copy of the letter that NHSE are sending patients who fall into this catergory. This is important as people considered to be vulnerable can register through the details in this letter to receive extra support as needed.

We are trying to contact patients who are affected by these new guidelines but please do call us and let us know if you think this includes your self and you haven’t heard from us.

Employment advice: What shall I do as an employer or employee? Particularly if I am being asked to support someone who is vulnerable according to the new shielding guidance.

If you are shielding and need to be able to discuss this with your employer the following links may be helpful

https://www.gov.uk/government/publications/guidance-to-employers-and-businesses-about-covid-19/covid-19-support-for-businesses

https://111.nhs.uk/isolation-note

If you have symptoms of COVID-19 or symptoms of ITP and are concerned about bleeding

Please also do let us know if you think you have been or are affected by the virus and are worried about your ITP. We know that viral infections can trigger a new ITP episode that can result in lower platelet counts that may need patients to be clinically reviewed.

Please do contact the haematology secretary number if you feel you need advice – on 020 8725 0885.

However if you have concerns about bleeding or if you cannot get through to us or it is out of hours please do attend the emergency department (A&E)

We know people may be worried about coming to the hospital at this time, but please be assured that the hospital have put significant measures in place to keep patients safe. You will be assessed and treated in the Emergency Department (A&E) in a similar way to usual, and if needed, admitted to a ward for care. If you think you need hospital care then please do not delay in coming to the Emergency Department.

Outpatient Appointments and Medication

  • Please continue to take your medication unless you are told specifically not to
  • Outpatient appointments are likely to be rearranged and will all be conducted via telephone. We will contact you to let you know of the new arrangements  – please see main haematology website for further details on how telephone clinics work https://www.stgeorges.nhs.uk/service/diagnostic-services/haematology/
  • Please do NOT come to the hospital unless told specifically that you need to or you need to seek urgent medical care via A&E
  • Please do NOT come to hospital or any centre for a planned appointment or blood test if you have symptoms of COVID-19 (cough or fever) – please let us know and we will rearrange
  • We will be in contact with you to explain how necessary blood tests will be done and how we will arrange delivery of medications for you

Team Support

The team will be as available as we can be, within the needs of a busy acute hospital at this time, and you can contact us via the main haematology number on 020 87250885.

If we are unavailable please leave a message and we will get back to you or try again later.

If how and who to contact changes over the next few weeks we will keep you updated.

If it is a medical emergency please call 999

Emotional Well Being

We recognise that the coming months may be worrying and difficult for many of us. If you are at home but don’t have any symptoms consider what you can do to maintain a routine, keep busy and remain healthy (e.g. by keeping hydrated, eating as well as you can, doing some gentle exercise). Please do draw on all your sources of support via telephone, text and social media. Many organisations have developed useful information, for example