Title: Thrombotic microangiopathy in two patient with COVID 19 disease
Abstract:Background : The new, pandemic disease of Severe Acute Respiratory Syndrome Coronairus 2 (SARS-CoV-2) causes a variety of symptoms in infected individuals, from very mild flu-like symptoms to fatal se...Background : The new, pandemic disease of Severe Acute Respiratory Syndrome Coronairus 2 (SARS-CoV-2) causes a variety of symptoms in infected individuals, from very mild flu-like symptoms to fatal severe pneumonia and organ failure. However, it is very interesting that we are seeing an increase in thrombotic microagiopathies (TMA) in connection with the disease caused by the new coronavirus (Covid 19). The persistent action of coronavir activates the complement system, including activation of coagulation. This is accompanied by the production of antibodies against ADAMTS13, which leads to a reduction in ADAMTS13 activity and the development of TMA with microthrombotizations in blood vessels, tissues and organ failure. Aims : Description of two case reports of hospitalized patients in the intensive care unit with Covid 19 and subsequently developed thrombotic microangiopathy. Methods : To diagnose TMA, two patients with Covid 19 infections had the following tests: blood count, platelet count (PLT), schistocyte count, lactate dehydrogenase, urea, creatinine, ADAMTS13 activity, and ADAMTS13 inhibitor. Results : Case report 1 -male 68 years old, Covid 19 positive, on the 5 day TMA is developed, PLT is 49 x 109/l, schistocytes 68/1000 erythrocytes, ADAMTS13 activity 43%, inhibitor 12 IU/ml. After exchange plasmapheresis patient's condition improves. Case report 2 -male 64 years old, Covid 19 positive, on the 8 day TMA is developed, PLT is 16 x 109/l, schistocytes 64/1000 erythrocytes, ADAMTS13 activity 29%, inhibitor 68 IU/ml. After exchange plasmapheresis patient's laboratory finding improves, but condition is very serious and patient die. Conclusions : Covid 19 infection can damage the endothelium, activate coagulation and complement, and subsequently develop thrombotic microangiopathy. Covid 19 brings a wide range of overlapping signs and symptoms, making it difficult to diagnose severe TMA. For this reason, treatment is often started late and some patients die.Read More