A Reported Incident
On April 24 of this 2020 Crisis – Dr. Hooman D. Poor, a pulmonologist in New York, was tired of seeing his patients die as of COVID 19, and it seems like another patient was slipping away.
The patient was on a ventilator, but it was not helping her anymore. Oxygen was not getting to her organs. The level of acid was rising in her blood.
Her body was in a shudder, and kidneys were failing, but the doctor could not put her on dialysis. She was moreover sick and probably would not survive it.
Dr. Hooman D. Poor was about to call her family to deliver this devastating news.
As he deliberates her lab results, he noticed that, like several other COVID-19 patients, she had high levels of protein parts called D-dimers, which are left over when the body produces blood clots. Her body was dreadfully trying, but failing, to clear blood clots, Hooman believed.
A COVID-19 Mystery
Around the globe, doctors treating COVID-19 patients have been trying to understand the same thing. When they extract blood from COVID patients, it clots in the tubes. When nurses insert hemodialysis catheters and IV lines to draw blood, the tubes become clogged rapidly.
As earlier a press release said that the “Passive immunization could save COVID-19 patients,” Dr. Tahir Shamsi said.
These COVID 19 patients are making clots all over Pakistan that is making treatment of these patients very challenging” observed by one of the best hematologists of Lifeline Hospital.
In addition to the recognized breathing problems, blood clots are also a substantial danger for COVID-19 patients.
Clots are instigating patients with COVID to have a stroke and heart attacks, forming strange red rashes on the skin and swollen wounds that look like frostbite on their toes and fingers.
On autopsy, the small vessels of the bowels and lungs, kidneys, and liver and of COVID patients are choked with clots.
A Case Study Brings The Light
Adam Cuker, a hematologist and associate professor of medicine at the Hospital of the University of Pennsylvania, gave his patient a powerful blood-thinning medication that is commonly used to treat strokes. It is risky, if misused, it can cause uncontrolled bleeding and can be fatal.
Within 30 minutes of taking the medication, his patient showed signs of improvement. Patients’ carbon dioxide levels are low, and other signs of shudder seem to be improving.
The patient lived for another week before finally dying. Adam Cuker said I tried the drug on other COVID-19 patients too. This did not help them survive, but he feels that it has shown him something about the disease.
It highlights the possibility that blood clots may play a more critical role in this disorder than we previously estimated, our hematologists said.
Lessons From The Unusual Incident
Dr. Tahir Shamsi, one of the best pathologists of Pakistan, has been performing an autopsy on patients who died with COVID-19.
So far, he has finished 20 cases and has one thing in common: He observed the full of blood clots in the smallest vessels in the body.
There, the clots appear to have reduced blood flow to the small air sacs where blood cells exchange oxygen and carbon dioxide. The lungs seem to be particularly affected.
Blood cannot flow and exchange oxygen as it should, Dr. Tahir Shamsi said.
Our hematologists say the pattern of damage is prominent.
“I have never had a series of cases like this, where everyone looks the same, and all the lungs have a similar outline. There are types of vascular lesions at autopsy that I have not been observed before. I would say it I really new, our hematologists said.
Dangerous blood clotting is a constant risk for patients with serious illnesses. This is especially true for those who freeze and mechanically ventilate devices, such as patients with COVID-19 often.
But a recent French study, comparing 150 patients with COVID-related respiratory failure who were treated in intensive care units with 145 patients with respiratory failure.
But who was not disease-ridden with the new-fangled Coronavirus, found significantly higher rates of blood coagulation in COVID patients.
Our hematologists said, we still need more controlled data. Still, based on clinical observations and the few published studies, it appears that thrombosis blood clotting is more common in these patients.
Still An Open Question
Why blood congeals the technique does in some COVID-19 patients?
One concept is that the body launches an immune attack called a cytokine storm to fight a self-targeting Coronavirus, which kills cells in an attempt to stop the infection.
The panel of Doctors in Pakistan believe that for some patients, an immune attack can cause more harm to the body than the Coronavirus itself.
This highly inflammatory condition is itself a known risk of blood clots. Cytokine storms can cause a disease called diffuse intravascular coagulation, or DIC, in which patients bleed uncontrollably and frequently clot at the same time.
Another significant possibility is that the Coronavirus may more directly cause the clotting.
New Research Is Here
A research message published this week in The Lancet reported evidence of viral antibodies against the new Coronavirus that invades endothelial cells.
The lining is the lining of blood vessels. It handles crucial functions in the vascular system, such as thrombosis and swelling.
Images captured under an electron microscope found traces of Coronavirus in the endothelial cells of the heart, kidneys, small intestine, and lung, almost throughout the body.
The researchers collected tissue while dissecting three patients who died of COVID-19.
DIP-CARD, Dr. M Arif, Cardiovascular Diseases Department at Lifeline Hospital, said that the results indicate that the virus can directly infect the lining.
He said that while COVID-19 can definitely cause respiratory problems, he does not think it is just a lung disease. Actually, it is a disease of the endothelium.
Dr. M Arif said that the infection begins in the lungs, as breathing is the prime way for the Coronavirus to enter the body.
Once it affects the lung cells and begins to destroy them, it travels to the bloodstream. There, it affects endothelial cells, causing endotheliitis.
Dr. M Arif thinks this endotheliitis not only comes from the direct infection of the blood vessel cells but also comes from the haywire cytokine storm that the body launches to fight against it.
Dr. M Arif says this theory of infection explains some things that doctors have been trying to puzzle out.
For example, conditions like high blood pressure, diabetes, and heart disease cause pressure on the lining. Not surprisingly, then, people with these conditions also develop the disease when they develop COVID-19.
It also helps explain the reason for the low blood oxygen level in patients. Still, their lungs may not be as firm as they are generally in patients suffering from shortness of breath with pneumonia.
Dr. M. Arif explains. I know that one of the results of endotheliitis is that the blood vessels cannot shrink as they usually do.
Usually, when part of the lung is damaged, the small blood vessels in that area are closed so that blood can flow to a part of the lung that is still working, where it can accumulate oxygen.
This system defends the body from a sudden drop in oxygen and appears to degrade in patients with severe COVID-19 infection. Dr. M. Arif believes that the cause is the endothelium.
The conclusion is that coagulation is a characteristic of COVID-19 syndrome. When it becomes a significant problem, the disease is very severe and advanced. For this reason, the treatment of the resulting blood clots may not work.
It is believed that something worth trying might be giving patients medications to support the lining, such as ACE inhibitors and statins, along with anti-inflammatory drugs to treat a cytokine storm early in the illness, but it is needed. More research to be sure.
If COVID-19 is really a widespread infection, Dr. M Arif believes. Knowing this also helps explain why the ventilator did not help increase the number of patients. A study of 5,702 patients hospitalized with COVID-19 in NYC found that while only 12.1% needed a respirator to help them breathe, 88.3% of these patients died.
It does not act like the flu or other bacterial pneumonia since it has inflammation in the lungs and the accumulation of fluid and very rigid lungs. It does not seem to be the case, at least early, as Dr. M. Arif said.
“The Coronavirus behaves as if its main target is the coating, Dr. M. Arif said.
It means that strokes are only part of a much bigger problem, and one of the poor says that doctors still don’t know how to solve them.