Department of Hematology and Oncology, St. Joseph University Medical Center, 703 Main Street, Paterson, NJ 07503, USA.
Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) National Institutes of Health, 6555 Rock Spring Dr, Bethesda, MD 20817, USA.
Blood Rev. 2021 Mar;46:100743. doi: 10.1016/j.blre.2020.100743. Epub 2020 Aug 18.
A novel coronavirus termed as COVID-19 by WHO has been the causative agent of an unprecedented pandemic in the history of humanity. The global burden of mortality and morbidity associated with this pandemic continues to increase with each passing day as it is progressively leading to multiorgan dysfunction. In most cases, the cause of death has been attributed to respiratory failure, sepsis, cardiac failure, kidney injury, or coagulopathy. As more knowledge is being unfolded, an in-depth understanding of various systemic manifestations and complications of SARS-CoV2 is vital for optimum management of these patients. This novel virus is known to spread faster than its two ancestors, the SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV), demonstrating a case fatality ranging from 5 to 8% [1]. Hematological abnormalities such as lymphopenia, thrombocytopenia, elevated D-Dimer, elevated fibrinogen, elevated fibrinogen degradation products as well as cytokines such as IL-6 are emerging as important prognostic marker for worse outcome of COVID-19. Among various systemic manifestations, hematological complications such as venous thrombosis causing pulmonary embolism or deep vein thrombosis, and arterial thrombosis causing myocardial infarction, strokes or limb ischemia are being noted to be directly linked to high mortality from COVID-19. An attempt to understand the pathophysiology of various hematological abnormalities including cytokine storm, hypercoagulable state and some rare presentations of this disease hence becomes imperative. Through this review, we aim to provide an up-to-date summary of current evidence-based literature of hematological manifestations, their consequences and management including role of anticoagulation and drugs targeting cytokine storm in patients with SARS-CoV-2.
世界卫生组织（WHO）将一种新型冠状病毒命名为 COVID-19，它是人类历史上史无前例大流行的病原体。随着这种大流行导致多器官功能障碍，与它相关的全球死亡率和发病率负担每天都在增加。在大多数情况下，死亡原因归因于呼吸衰竭、败血症、心力衰竭、肾损伤或凝血功能障碍。随着更多的知识被揭示，深入了解 SARS-CoV2 的各种全身表现和并发症对于这些患者的最佳管理至关重要。这种新型病毒的传播速度比它的两个祖先——严重急性呼吸综合征冠状病毒（SARS-CoV）和中东呼吸综合征冠状病毒（MERS-CoV）更快，其病死率范围为 5%至 8%[1]。血液学异常，如淋巴细胞减少症、血小板减少症、D-二聚体升高、纤维蛋白原升高、纤维蛋白原降解产物升高以及白细胞介素 6（IL-6）等细胞因子，正成为 COVID-19 预后不良的重要预后标志物。在各种全身表现中，血液学并发症，如导致肺栓塞或深静脉血栓形成的静脉血栓形成，以及导致心肌梗死、中风或肢体缺血的动脉血栓形成，被认为与 COVID-19 的高死亡率直接相关。因此，了解包括细胞因子风暴、高凝状态和这种疾病的一些罕见表现在内的各种血液学异常的病理生理学变得至关重要。通过本次综述，我们旨在提供关于 SARS-CoV-2 患者血液学表现、其后果和管理的最新循证文献的综合概述，包括抗凝治疗和靶向细胞因子风暴药物的作用。
