COVID-19 and Haemostasis

https://www.werfen.com/uk/en/covid-19-and-implications-haemostasis-and-viscoelastic-testing Read this article today produced by Werfen, which highlighted the effects of COVID-19 on haemostasis. Haemostasis testing has become important in the management of these patients, particularly the severe cases. It discusses how D-Dimer, Prothrombin Time, platelet count and Fibrinogen are of particular use in hospital admissions. COVID-19 causes the following changes in Haemostais tests.

It also discusses how D-Dimer, prothrombin time, platelet count and Fibrinogen are of particular use in determining hospital admissions.

It seems that all COVID-19 patients are treated with low molecular weight infractionated heparin to reduce the risk of thrombotic complications.

Oxidative stress and Haemolysis

So here we go, my first Post! 

 I recently looked urgently at this blood film on a neonate with unexplained anaemia. The striking feature of this blood film for me, were large numbers of irregularly contracted cells. Irregularly contracted cells in large numbers can be seen in a red cell enzymopathies or Haemoglobin C. In the case of red cell enzymopathies they are likely to be accompanied by keratocytes (bite cells) and hemighosts. In the case of Haemoglobin C, target cells would also be a prominent feature. 

 I think this is a classic a oxidative hemolysis picture, because of the large numbers of irregularly contracted cells, polychromasia and keratocytes. We are awaiting results of the G6PD assay as a possible cause. Reading up on the process involved here, it seems that G6PD has a protective role on the red blood cell, and prevent reactive oxygen species, the byproduct of normal cell fuctions, from building up to toxic levels. If this enzyme is lacking, infections, drugs and fava beans can increase levels of reactive oxygen species, causing red cells to be destroyed faster than the body can replace them. Interestingly however this patient was female, and G6PD deficiency occurs predominantly in hemizygous males, although deficiency can occur in homozygous females. 

 We will wait and see the outcome of the results!