Sartorisu-Sowmya eBook - 21

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DECIPHERING THE IMMUNE RESPONSE TO VIRAL INFECTION

James O'Donnell, MD, director of the Irish Centre for
Vascular Biology, RCSI University of Medicine and
Health Sciences, and consultant hematologist in the
National Coagulation Centre in St James's Hospital,
Dublin.

21 | GENengnews.com

supportive care, including the use of
supplemental oxygen where indicated,
and low molecular weight heparin
(LMWH) for thromboprophylaxis, unless
contraindicated.
The patients underwent a range
of tests at admission and throughout
hospitalization, including measures of
coagulation, D-dimer level, platelet
counts, and fibrinogen testing. The cohort
was also split into two groups based on
whether they had to be admitted to the
ICU for ventilator support or died due to
COVID-19 infection, versus those who were
discharged without requiring ICU support.
The researchers observed elevated
D-dimer levels at admission, which
remained higher in those patients who
eventually needed ICU admission.
"Similarly, fibrinogen and CRP levels were
also both significantly elevated in the
poor prognosis group," the authors wrote.
"The marked increase in D-dimer levels
is consistent with progressive activation,
along with concurrent activation of

fibrinolysis within the lungs." However,
they noted that despite increased D-dimer
levels, platelet counts were normal. "Thus,
despite the fact that thrombotic risk is
much higher in Caucasian patients and
the significant elevated levels of D-dimers
observed, overt DIC as defined according
to the ISTH SSC DIC score was present in
none of our COVID-19 patients at time of
admission."
Reporting on their findings, the
investigators said that the observation
that abnormal coagulation parameters
on admission to hospital were linked with
poorer prognosis in Caucasian patients
with COVID-19 infection was in keeping
with previous Chinese data.
"In addition to pneumonia affecting
the small air sacs within the lungs, we are
also finding hundreds of small blood clots
throughout the lungs," O'Donnell stated.
"This scenario is not seen with other types
of lung infection, and explains why blood
oxygen levels fall dramatically in severe
COVID-19 infection."
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