Acute blood loss anemia after COVID-19 nasopharyngeal sampling

Long-term care residents with novel coronavirus disease 2019 (COVID-19) experience high mortality rates and require frequent screening. Most resident testing occurs via nasopharyngeal swab that potentially causes epistaxis with rates of 5% to 8% in healthy populations. It is estimated that 48% of long-term care residents receive oral anticoagulation that increases risk of bleeding. A long-term care resident receiving oral anticoagulation experienced an episode of acute blood loss anemia after nasopharyngeal sampling. Current medications were not reviewed before testing, and oral anticoagulation was not held resulting in acute blood loss anemia. A medication review is indicated for skilled nursing and assisted living residents to identify oral anticoagulation before nasopharyngeal testing. Less invasive testing may be recommended or should bleeding occur, discontinuation of oral anticoagulation for a short term may be appropriate.