Haemoglobin disorders and COVID-19 — what do we know so far?

Preliminary research conducted in Europe has shed light on the risk of COVID-19 complications in patients with common haemoglobin disorders. However, the researchers say current data is scarce, meaning firm conclusions cannot yet be drawn.

The pioneering research from Thalassemia International Federation has gathered data from all known COVID-19 patients, globally, that live with haemoglobin disorders (HDs).

While still ongoing, the research has given some indication that people living with HDs like sickle-cell disease (SCD) and thalassemia are more vulnerable to the virus.

Thalassemia, also known as Mediterranean anaemia, is prevalent in Australia — given the high Greek, Lebanese and Syrian populations — with around 850,000 living with the condition.

In its major form, beta thalassemia, the disorder carries complications like severe iron overload, heart and liver damage, diabetes and pulmonary hypertension; and requires monthly blood transfusions.

SCD — a disease which causes red blood cells to break down — is also common. Although Australian data is lacking, global figures show that SCD accounts for 83% of all HDs.

The research so far has shown that SCD patients are particularly vulnerable to COVID-19, with a 17% death rate from the small sample observed.

“The disease can be triggered by any virus, even bacteria,” said Dr Michael Angastiniotis of TFI.

Conversely, thalassemia carries a relatively low risk. However, complications of the condition could increase the likelihood of serious illness from COVID-19.

“As thalassemia patients grow, they tend to develop complications that affect the heart, liver, endocrine glands. One of these endocrine complications is diabetes, which we already know makes patients more vulnerable to the virus,” said Dr Angastiniotis.

However, since the data is global, more work needs to be done in an Australian context, Angastiniotis added.

He noted that SCD and thalassemia patients stand a much stronger chance of recovery from COVID-19 in countries with optimal healthcare systems.

“We need to remember that just 5% of the global population of people living with thalassemia and SCD live in countries with optimal care. The remaining 95% are treated suboptimally,” he said.

“To this end, I am particularly concerned about Asian countries, as they have large populations of HD sufferers and, often, inadequate health infrastructure.”

The findings — although based on a small sample which may not translate to the general population — hint that extra care must be taken to protect SCD and thalassemia patients from the virus victims.

“Most beta thalassemia patients are transfusion dependent and have no choice but to visit transfusion centres within hospitals, on a monthly basis,” Angastiniotis said.

“Given that hospitals are highly infectious environments, hospitals should consider isolating HD patients from suspect COVID-19 cases and creating a separate triage area for those living with these conditions.

“Blood shortages during lockdown also put transfusion-dependent cases at increased risk; and so blood donations must be kept up.”

TIF gives further recommendations on its website.

Image credit: ©stock.adobe.com/au/elnur