Hematologic parameters in coronavirus infection (COVID-19) and their clinical implications

Abstract

Coronaviruses are a class of enveloped RNA viruses that cause infections of the respiratory tract, characterized by fever, tiredness, dry cough, diarrhea, loss of smell or taste, chest pain and shortness of breath. Many patients with mysterious pneumonia were distinguished in December 2019 in Wuhan. The pneumonia of obscure origin was found to be ascribed to a novel coronavirus and described as novel coronavirus pneumonia (NCP). The Chinese authorities initially reported the wave of mysterious pneumonia on December 31st, 2019 and it was declared as an outbreak of international concern on January 30th, 2020. A systematic search of relevant research was conducted, and a total of 58 primary research articles were identified, analyzed, and debated to better understand the hematologic profile in COVID-19 (Coronavirus disease) infection and its clinical implications. All the findings in this article manifest a true impression of the current interpretation of hematological findings of the SARS-COV-2 disease. Pathophysiology of COVID-19 disease can be better interpreted by taking into consideration the hematologic parameters. Clinical implications of the hematologic profile of COVID-19 patients including cytokine storm, coagulation profile, and thrombophilic complications are under-recognized. Therefore, this review focuses on the coagulation profile, cytokine storm, and its treatment options. The role of pre-existing thrombophilia in COVID-19 patients and how it could result in the poor prognosis of the disease is also debated. The recent data suggests that hypercoagulability could be the potential cause of fatalities due to COVID-19. Potential effects of tocilizumab, metronidazole, and ulinastatin in suppressing cytokine storm may help to treat SARS-COV-2 infection. This review also highlights the significance of thrombophilia testing in SARS-CoV-2 patients depending on the clinical features and especially in pregnant women.

History of COVID-19 Was Not Associated With Length of Stay or In-Hospital Complications After Elective Lower Extremity Joint Replacement

“…2 Patients were asked at presurgical screening if they had been exposed to a suspected or confirmed COVID-19 case within the past two weeks. 3 Patients were asked at presurgical screening if they had experienced any COVID-19 related symptoms within the past two weeks.…”

“…The novel coronavirus, SARS-CoV-2, has caused millions of deaths worldwide as part of a global pandemic; the impact of persistent health effects among survivors of COVID-19 remains under evaluation [1,2]. Beyond upper and lower respiratory symptoms commonly reported in COVID-19, systemic effects including thrombophilia [3], myocarditis [4,5], and neuropathy [6,7] have been reported. Other symptoms including fatigue and malaise [8] can persist months after resolution of primary illness.…”

Microangiopatía trombótica sistémica asociada a infección activa por SARS-CoV-2: a propósito de un caso

“…El estado protrombótico que acompaña a la enfermedad ha sido conocido desde los primeros casos de la infección y se manifiesta con elevación de marcadores como dímero D y fibrinógeno, hasta aparición de eventos trombóticos tipo coagulación intravascular diseminada o coagulopatía inducida por sepsis. La hipoxia tisular, el daño endotelial y el estado de inflamación persistente que acompaña la infección se han descrito como explicaciones fisiopatológicas asociadas con una activación anormal de la cascada de coagulación durante el curso de la enfermedad 2 . Los datos iniciales de series de casos en China describieron parámetros de coagulación alterados en pacientes con COVID-19, mientras que una elevación del dímero D de forma significativa se asoció directamente con la gravedad de la enfermedad, el requerimiento de ventilación mecánica y un aumento en la mortalidad 3 , la elevación de fibrinógeno se ha asociado con disfunción endotelial y respuesta inflamatoria mayor en la progresión de la enfermedad 4 .…”