Apr 24, 2020 21:00:00

Patients who become severe due to new coronavirus infection may have major problems with 'blood'

The new coronavirus infectious disease (COVID-19), which is raging all over the world, does not make everyone serious, and some people may have mild symptoms, and some may even be infected without symptoms. Some people go unnoticed. While many researchers are studying the symptoms of COVID-19, it has been pointed out that 'blood problems' are widespread in patients with severe disease.

Elevated Plasmin (ogen) as a Common Risk Factor for COVID-19 Susceptibility | Physiological Reviews

https://journals.physiology.org/doi/full/10.1152/physrev.00013.2020

Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: A report of five cases
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7158248/

Faulty blood clotting mechanism may explain COVID-19 severity
https://www.medicalnewstoday.com/articles/faulty-blood-clotting-mechanism-may-explain-covid-19-severity

Severe COVID-19 patients have 'unprecedented' blood clots. Here's what doctors know-National | Globalnews.ca
https://globalnews.ca/news/6851642/blood-clots-coronavirus/

Factors that increase the risk of COVID-19 severity include diabetes, respiratory disease, heart disease, cerebrovascular disease, high blood pressure,

chronic obstructive pulmonary disease , and kidney disease. The findings, newly published in the medical journal Physiological Reviews , point out that internal bleeding and bleeding disorders may be one of the leading causes of death in COVID-19 patients.

According to a research team of Professor Hong-Long Ji who studies cell and molecular biology at the University of Texas Health Science Center Tyler (UTHCT) , hyperactivity of anticoagulant reaction that the body suppresses blood coagulation is COVID -19 The patient's body may cause excessive bleeding, possibly resulting in dysfunction.

The fibrinolytic system that prevents blood from coagulating is a necessary function to remove clots that have clots . plasma ( Ok ) The fibrinolytic system clears the blood clots in the blood vessels by activating the precursors plasminogen present in them into plasmin , which breaks down the fibrin that forms the clot.

The research team of Professor Ji and colleagues pointed out that changes were observed in the body of severely ill patients with COVID-19, such as increased byproducts of fibrin degradation and decreased platelets. Since people with diabetes, heart disease, lung disease, kidney disease, etc. often show high levels of plasminogen and plasmin, excessive hyperactivity of the fibrinolytic system occurs in COVID-19 patients, It is possible that bleeding may occur in multiple organs, resulting in a fatal situation.

In addition, 97% of patients who were hospitalized due to severe COVID-19 pathology have increased the amount of

D-dimer blood protein produced by fibrin degradation, research results There is also. Particularly, COVID-19 patients who became severe enough to develop acute respiratory distress syndrome (ARDS) had a significantly high amount of D-dimer.

From a series of studies, Ji and colleagues pointed out that the amount of D-dimer may be associated with the severity of COVID-19. 'The time it takes for the amount of elevated D-dimer to decrease depends on the severity of COVID-19. Generally, in mild patients, the amount of D-dimer decreases in about a week,' , It will be longer in critically ill patients, 'the research team concluded, and the amount of plasmin and D-dimer in the blood could be an important biomarker for COVID-19 severity.

While hyperactivity of the fibrinolytic system that prevents blood coagulation is reported, COVID-19 patients often have thrombus throughout the body, such as the lungs and the inside of the skin. Blood clots in COVID-19 patients are a major previously unknown problem, according to

Jeffrey Laurence , a hematologist at Weyl Cornell Medical College in New York.

Laurence and colleagues found blood clots in the lungs of two patients who died of COVID-19, and in three surviving patients, blood clots inside the skin, including the palms and feet. did. A Dutch (PDF file) study also found blood coagulation problems in 31% of the 184 patients who entered the ICU for COVID-19, as well as 71% of COVID-19 patients who died in a Chinese study. It has been reported that a small blood clot was confirmed in.

It seems that some hospitals are beginning to give high doses of anticoagulants to COVID-19 patients, but Michelle Sholzberg, who studies blood coagulation at St. Michaels Hospital in Toronto, says It was pointed out that it increases the risk of bleeding. He argued that clinical trials were needed to explore the mechanisms of blood coagulation and effective treatments in COVID-19 patients.

The reason for the rapid increase in blood clots in COVID-19 patients is unclear, but one hypothesis has been that the virus may cause severe inflammation in the human body, possibly overreacting with the immune system. . 'The system of inflammation and the system of blood coagulation are very closely linked,' said Sholzberg, but it is still too early to understand the association between COVID-19 patients and blood clots.