In the United States alone, nearly half a million people currently suffer from end-stage kidney disease and must undergo hemodialysis several times a week. For these patients, the vascular access site is quite literally their lifeline, as it provides direct access to their bloodstream for the life-saving treatments.
Yet due to the current COVID-19 outbreak, procedures to establish these vascular access sites have been deemed “non-essential” elective procedures by CMS and HHS, and nephrologists and vascular surgeons are finding themselves unable to secure operating room time.
Though we must all work together during this crisis to reduce the intense strain on our healthcare system, this decision could have devastating implications for patients with end-stage kidney disease — a group that is already highly vulnerable to potential complications of COVID-19. Limiting access to these procedures will increase reliance on riskier vascular access options that significantly increase patients’ chances of infection, hospitalization and even death. This will only add to the strain on resources as hospitals continue to deal with the outbreak.
Multiple myeloma is the most common hematological malignancy. It forms in plasma cells, white blood cells found mainly in the bone marrow that protect the body from infection by producing antibodies. When these cells become malignant, abnormal plasma cells accumulate in the bone marrow, producing abnormal antibodies and crowding out normal blood-forming cells. Some of these abnormal cells, known as circulating multiple myeloma cells (CMMC), escape from the primary tumor space and travel through the bloodstream.
Current approaches for diagnosing patients with multiple myeloma require bone marrow aspiration and biopsy. These are invasive procedures that use a hollow needle inserted into the hipbone or breastbone to remove bone marrow, blood, and a small piece of bone. While generally safe, bone marrow exams can result in excessive bleeding, infection, and long-lasting discomfort.