. 2020 Jul 13;105(4):378–386. doi: 10.1111/ejh.13476

TABLE 1.

Risk levels in patients with haemoglobinopathies and corresponding guidance considerations regarding work, schooling or educational activities

Risk level	Criteria	Guidance
Group A: Moderate risk	Thalassaemia patient with all of the following: Optimal transfusions with pre‐transfusion Hb 9.5‐10.0 g/dL (for ≥3‐4 previous years) Optimal iron chelation with cardiac T2* >20ms, LIC < 7 mg/g DW or serum ferritin < 2000 mg/L (for ≥3‐4 previous years) No underlying comorbidities No splenectomy	Assume work/schooling/education without any additional measures besides national guidelines for general population (distancing, hand washing, wearing mask)
Group B: High risk	Thalassaemia patient with 2 or more of the following: Suboptimal transfusions with pre‐transfusion Hb 8.0‐9.0g/dl (currently and in ≥2‐3 previous years) Moderate iron load with cardiac MRI T2* 10‐20 ms, LIC 7‐10 mg/g DW or serum ferritin 2000‐4000 mg/L (currently and in ≥2‐3 previous years) One underlying comorbidity including diabetes, cardiac, endocrine, hepatic or respiratory disease Splenectomy	Assume work/schooling/education keeping national guidelines for general population (distancing, hand washing, wearing mask) unless job involves treating/caring patients or other vulnerable groups (eg healthcare professionals) or frequent contact with people (eg receptionists, shop assistants)
Group C: Highest risk	Sickle cell disease patient Thalassaemia patient with 2 or more of the following: Age > 50 years Suboptimal transfusions with pre‐transfusion Hb < 7 g/dL (currently and in ≥2‐3 previous years) Severe iron load with cardiac MRI T2* <10 ms, LIC > 10 mg/g DW or serum ferritin > 4000 mg/L (currently and in ≥2‐3 previous years) One or more underlying comorbidity including diabetes, cardiac, endocrine, hepatic or respiratory disease Splenectomy with one or more of comorbidities	Refrain from any type of work/schooling/education activities and remain at home, avoiding any gatherings or contact with potential COVID‐19 (egrelative symptoms) until the pandemic is declared well over at country level. Keep national guidelines of distancing, hand washing and wearing mask at least 6 mo after the pandemic is declared over at country level

Risk level

Criteria

Guidance

Group A: Moderate risk

Thalassaemia patient with all of the following:

Optimal transfusions with pre‐transfusion Hb 9.5‐10.0 g/dL (for ≥3‐4 previous years)
Optimal iron chelation with cardiac T2* >20ms, LIC < 7 mg/g DW or serum ferritin < 2000 mg/L (for ≥3‐4 previous years)
No underlying comorbidities
No splenectomy

Assume work/schooling/education without any additional measures besides national guidelines for general population (distancing, hand washing, wearing mask)

Group B: High risk

Thalassaemia patient with 2 or more of the following:

Suboptimal transfusions with pre‐transfusion Hb 8.0‐9.0g/dl (currently and in ≥2‐3 previous years)
Moderate iron load with cardiac MRI T2* 10‐20 ms, LIC 7‐10 mg/g DW or serum ferritin 2000‐4000 mg/L (currently and in ≥2‐3 previous years)
One underlying comorbidity including diabetes, cardiac, endocrine, hepatic or respiratory disease
Splenectomy

Assume work/schooling/education keeping national guidelines for general population (distancing, hand washing, wearing mask) unless job involves treating/caring patients or other vulnerable groups (eg healthcare professionals) or frequent contact with people (eg receptionists, shop assistants)

Group C: Highest risk

Sickle cell disease patient
Thalassaemia patient with 2 or more of the following:
1. Age > 50 years
2. Suboptimal transfusions with pre‐transfusion Hb < 7 g/dL (currently and in ≥2‐3 previous years)
3. Severe iron load with cardiac MRI T2* <10 ms, LIC > 10 mg/g DW or serum ferritin > 4000 mg/L (currently and in ≥2‐3 previous years)
4. One or more underlying comorbidity including diabetes, cardiac, endocrine, hepatic or respiratory disease
5. Splenectomy with one or more of comorbidities

Refrain from any type of work/schooling/education activities and remain at home, avoiding any gatherings or contact with potential COVID‐19 (egrelative symptoms) until the pandemic is declared well over at country level.

Keep national guidelines of distancing, hand washing and wearing mask at least 6 mo after the pandemic is declared over at country level