Changes in the Blood Viscosity in Patients With SARS-CoV-2 Infection

Abstract

Coronavirus disease 2019 (COVID-19) is caused by a novel virus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS-CoV-2-induced hyperinflammation together with alteration of plasma proteins, erythrocyte deformability, and platelet activation, may affect blood viscosity. Thus, this review aimed to study the link between SARS-CoV-2 infection and alteration of blood viscosity in COVID-19 patients. In order to review findings related to hyperviscosity in COVID-19, we suggested a protocol for narrative review of related published COVID-19 articles. Hyperviscosity syndrome is developed in different hematological disorders including multiple myeloma, sickle cell anemia, Waldenstorm macroglobulinemia, polycythemia, and leukemia. In COVID-19, SARS-CoV-2 may affect erythrocyte morphology via binding of membrane cluster of differentiation 147 (CD147) receptors, and B and 3 proteins on the erythrocyte membrane. Variations in erythrocyte fragility and deformability with endothelial dysfunction and oxidative stress in SARS-CoV-2 infection may cause hyperviscosity syndrome in COVID-19. Of interest, hyperviscosity syndrome in COVID-19 may cause poor tissue perfusion, peripheral vascular resistance, and thrombosis. Most of the COVID-19 patients with a blood viscosity more than 3.5 cp may develop coagulation disorders. Of interest, hyperviscosity syndrome is more commonly developed in vaccine recipients who had formerly received the COVID-19 vaccine due to higher underlying immunoglobulin concentrations, and only infrequently in those who have not received the COVID-19 vaccine. Taken together, these observations are untimely too early to give a final connotation between COVID-19 vaccination and the risk for development of hyperviscosity syndrome, consequently prospective and retrospective studies are necessary in this regard.

SARS-CoV-2 Altered Hemorheological and Hematological Parameters during One-Month Observation Period in Critically Ill COVID-19 Patients

“…These alterations could be related to changes in cell physical properties, as plasma membrane composition interact with the cytoskeleton to affect the shape and size of RBCs, which is critical for microcirculatory flow [ 27 , 45 ]. There are several surface receptors where the SARS-CoV-2 can enter the cell [ 46 ] in RBCs, most notably via binding of membrane cluster of differentiation 147 (CD147) or Band-3 protein on the erythrocyte membrane, negatively affecting erythrocyte morphology and function [ 47 , 48 ]. This includes RBCs’ coping with oxidative stress [ 47 ] as well as hyperviscosity, hyperaggregation, and reduced deformability [ 48 ].…”

“…There are several surface receptors where the SARS-CoV-2 can enter the cell [ 46 ] in RBCs, most notably via binding of membrane cluster of differentiation 147 (CD147) or Band-3 protein on the erythrocyte membrane, negatively affecting erythrocyte morphology and function [ 47 , 48 ]. This includes RBCs’ coping with oxidative stress [ 47 ] as well as hyperviscosity, hyperaggregation, and reduced deformability [ 48 ]. In this context, the binding of the SARS-CoV-2 Spike protein to Band-3 protein on the erythrocyte membrane was suggested to result in morphological abnormalities but also affect the release of oxygen to metabolically active tissues and COVID-19 worsening [ 47 ].…”

Mixed storm in SARS‐CoV‐2 infection: A narrative review and new term in the Covid‐19 era

“…During SARS‐CoV‐2 infection and associated cytopathic injury, PAMPs are released which activate PRRs. The interaction between PAMPs and PRRs triggers innate immune response for expression and release of proinflammatory cytokines, adhesion molecules, chemokines, and inflammatory signaling pathways like NF‐κB 43–45 …”

Sensing of Fluidic Features Using Colloidal Microswarms

“…Sensing of key parameters (e.g., viscosity and ionic strength) in physiological environments has attracted extensive attention. − The blood viscosity is an important determinant associated with the cardiovascular diseases, − such as stroke and coronary heart disease. The inflammation could also cause alterations of blood viscosity . In addition, the ionic strength plays a crucial role in biological reactions, such as affecting the enzymatic activity and protein structure .…”

“…The inflammation could also cause alterations of blood viscosity. 8 In addition, the ionic strength plays a crucial role in biological reactions, such as affecting the enzymatic activity and protein structure. 9 The ionic strength will also govern the cell volume, and thus, the integrity of cell membranes and cytoskeletal architectures can be maintained.…”