CHICAGO – Most of the morbidity and mortality seen with COVID-19 involves the lower respiratory track, but the virus also can involve several organ systems and the syndrome.
Noting that the novel coronavirus has a wide range of symptoms and manifestations, a report in Leukemia & Lymphoma points out, “The involvement of elements of the hematopoietic system is prominent in severe cases and associated with poor outcomes and mortality.”1
A study team involving the Robert H. Lurie Comprehensive Cancer Center at Northwestern University, the Feinberg School of Medicine at Northwestern University and the Jesse Brown VAMC, all in Chicago, as well as Weill Cornell Medicine in New York explained that lymphopenia, leukopenia, thrombocytopenia, disseminated intravascular coagulation, and a prothrombotic state are common manifestations of COVID-19, adding that those have important treatment and prognostic implications.
“Better understanding of the mechanisms of the pathophysiology of COVID-19-induced hematological abnormalities may ultimately result in better ways to treat them and decrease the associated morbidity and mortality,” the authors wrote.
The report described how the virus acts mainly through hyperactivation of a systemic inflammatory response, i.e., a “cytokine storm,” which can exhaust the immune system, deplete certain immune cells, decrease production of hematopoietic stem cells and activate the coagulation cascade.
“Although patients suffering from COVID-19 can develop DIC and have bleeding complications, most present with thrombotic episodes that can be either venous or arterial,” according to the article.
Researchers emphasized that, despite popular belief, many younger patients are presenting with thrombotic complications. They pointed to a recent study advising that large vessel stroke can be the initial presenting clinical feature in relatively young patients with COVID-19.
“Looking into laboratory parameters will help us predict outcomes and severity of disease, in the hope of designing strategies to manage potential complications such as cytopenia, disseminated intravascular coagulation, VTEs, CVD, cardiac injury etc.,” the authors wrote. “In addition to designing and being involved in clinical trials, developing and spreading testing kits, one strategy should aim at building predictive models that would combine inflammatory and coagulation markers with clinical features and predict life threatening emergencies such as thrombosis and DIC”
Researchers suggested that those types of models could guide early clinical decisions on issues such as full versus prophylactic anticoagulation and thresholds for blood product transfusions.
- Mina A, van Besien K, Platanias LC. Hematological manifestations of COVID-19 [published online ahead of print, 2020 Jul 9]. Leuk Lymphoma. 2020;1-9. doi:10.1080/10428194.2020.1788017