Rotational thromboelastometry (ROTEM) profiling of COVID-19 patients

Background : Administration of a standard-dose thromboprophylaxis in all hospitalized Coronavirus disease (COVID-19) patients is recommended. However, despite thromboprophylaxis, frequent thrombotic complications are diagnosed. Rotational thromboelastometry (ROTEM) is a method to access hypercoagulable state in whole blood from these patients. Aims : To analyze ROTEM parameters during the entire clinical COVID-19 stages including mild, moderate and critical phases and to assess the extent of hypercoagulablity by profiling ROTEM patterns. Methods : We evaluated coagulation abnormalities via traditional tests and ROTEM profile in a group of 94 patients with confirmed SARS-CoV-2 infection with different severity of pneumonia (34 moderate, 25 severe, 35 critical). Shorter than normal clotting time (CT) and higher than normal maximum clot firmness (MCF) in extrinsic rotational thromboelastometry (EXTEM) and fibrinogen rotational thromboelastometry (FIBTEM), shorter than normal EXTEM clot formation time (CFT), and higher than normal α-angle were identified as markers of hypercoagulable state. Results : At least one hypercoagulable ROTEM parameter had 62 (66%) patients. Increment in the number of patients with ≥ 2 hypercoagulable parameters, higher EXTEM ( P = .0001), FIBTEM MCF ( P = 0.0001) and maximum lysis decrement ( P = 0.002) with increment in disease severity was observed ( P = 0.0001). Significant positive correlations between IL6 and CT EXTEM ( P = 0.003), MCF EXTEM ( P = 0.033), MCF FIBTEM ( P = 0.01), and negative with ML EXTEM ( P = 0.006) were seen. Conclusions : These findings confirm that a hypercoagulable ROTEM profile characterized by clot formation acceleration, high clot strength, and reduced fibrinolysis was more frequent in advanced disease groups and patients with elevated IL6. These results underscore the need for different thromboprophylactic approaches for different severity groups.

SARS-COV-2 infection in a patient with Evans syndrome: a silent enemy or an ally?

Introduction. During the current outbreak of Coronavirus disease 2019 (COVID-19), the way to manage patients with autoimmune diseases remains elusive due to limited data available. Case report. We presented a case of a COVID-19 positive 20-year-old female with prior history of Evans syndrome. The patients remained asymptomatic even though she had been treated with immunosuppressants (prednisolone and azathioprine) together with romiplostim. Moreover, her course of infection was accompanied by thrombocytosis, although her platelet count was mostly below the reference range before the infection. The patient was monitored vigilantly, with special regard to platelet count and signs of thrombotic events. Conclusion. Platelet count monitoring and romiplostim administration should be performed more cautiously in chronic immune thrombocytopenic patients infected by SARS-CoV-2.