The aim of the present study was to assess whether patients with pulmonary embolism (PE) could be managed as outpatients after early discharge from hospital using low molecular weight heparin instead of remaining as in-patients until effective oral anticoagulation was achieved.Phase 1 of the study identified criteria for the safe discharge of selected patients; phase 2 treated a cohort of low-risk patients with PE as outpatients with tinzaparin using existing deep venous thrombosis services.In phase 1, 127 (56.4%) of 225 patients were considered unsuitable for outpatient management. Reasons included: admission for another medical reason; additional monitoring or requirement for oxygen; bleeding disorders; previous PE/further PE while on warfarin; co-existing major deep venous thrombosis; likelihood of poor compliance; significant immobility; and pregnancy. In phase 2, 157 patients with PE received outpatient anticoagulation therapy. There were no deaths, bleeding or recurrent thromboembolic events during acute treatment with low molecular weight heparin. The median (range) length of hospital stay was 1.0 (1-4) day, with a median saving of 5.0 (1-42) bed-days per patient.Patients were highly satisfied with outpatient management; 144 (96.6%) indicated that they would prefer treatment as outpatients for a subsequent pulmonary embolism. Early discharge and outpatient management of pulmonary embolism appears safe and acceptable in selected low-risk patients, and can be implemented using existing outpatient deep venous thrombosis services.

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With the recent Pandemic of Covid-19 affecting more than 180 countries across the globe, services to children with blood disorders and cancers are likely to be affected. Children, in general, are at lesser risk of developing severe diseases and mortality, and mostly recover from it; fortunately, till date, very few cases have been reported in children with cancers. However, since this is an unprecedented pandemic, there is a felt need for guidance on the challenges faced in providing care to children with cancers and various blood disorders including those requiring Hematopoietic Stem Cell Transplantation (HSCT). This document will provide guidance on how to maintain continuity of care for children with blood disorders & cancers during the COVID-19 pandemic while exercising all precautions to reduce the risk of Covid-19 in this vulnerable group and if infected, what optimum care should be provided to these children.

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