Impact of COVID-19 pandemic on the quality and performance of haemostasis laboratories

Background : The high incidence of thrombotic events in patients with COVID-19 affects healthcare worldwide and results in an increased workload in haemostasis laboratories. Especially D-dimer, haemostatic parameters and anti-Xa tests are expected to be analysed more frequently. However, the impact of this increase in assay requests on the quality of performance in haemostasis laboratories remains unclear. Aims : To evaluate the impact of the COVID-19 pandemic on the quality performance and management of haemostasis laboratories. Methods : The impact on the quality of performance was studied using external quality assessment (EQA) data from 2019 and 2020 derived from ECAT surveys. A questionnaire was sent to Dutch haemostasis laboratories to identify challenges and management strategies during the COVID-19 pandemic with focus on D-dimer, anti-Xa, factor VIII and fibrinogen. Furthermore, the number of assays performed in 2019 and 2020 was collected from four Dutch hospitals, located in regions with different disease incidence. Results : No differences in response rate nor the quality of the measurements were observed between the EQA surveys in 2019 and 2020 (Table 1). Fifty-five percent of the laboratories observed a more than 25% increase in test requests for anti-Xa and D-dimer assays in 2020 compared to 2019. Twenty-seven percent also experienced this increase in requested fibrinogen assays. Additionally, 84% of the respondents indicated to experience increased work pressure and increased absenteeism in 71% of the participating laboratories was observed. Evaluation of the number of assays performed over the year showed extreme peaks in anti-Xa assays (144 -772%) in all four hospitals and D-dimer assays (368%, 670%) in the two hospitals that are located in areas with high disease incidence. Conclusions : The enormous increase in work pressure and test requests, especially for D-dimer assays and anti-Xa activity, did not affect the quality of performance within haemostatic laboratories during the COVID-19 pandemic.