Division of Pulmonary Diseases and Critical Care Medicine, Yale-New Haven Health Bridgeport Hospital, 267 Grant Street, Bridgeport, CT, 06610, USA.
Division of Hematology and Oncology, William Beaumont Hospital, Oakland University, Royal Oak, MI, USA.
Ann Hematol. 2021 Feb;100(2):309-320. doi: 10.1007/s00277-020-04366-y. Epub 2021 Jan 7.
Coronavirus disease 2019 is caused by severe acute respiratory syndrome coronavirus 2. Primarily an infection of the lower respiratory tract, it is now well known to cause multisystem abnormalities. Hematologic manifestations constitute a significant area of concern. Severe acute respiratory syndrome coronavirus 2 infects monocytes and endothelial cells leading to a complex downstream cascade, cytokine storm, and eventual intravascular thrombosis. Coronavirus disease 2019 causes lymphopenia, neutrophilia, and thrombocytopenia. Prophylactic anticoagulation is vital in patients with coronavirus disease 2019, as its effect on the coagulation system is associated with significant morbidity and mortality. The disease can cause both arterial and venous thromboses, especially pulmonary embolism and pulmonary microthrombi. A high index of suspicion is indispensable in recognizing these complications, and timely institution of therapeutic anticoagulation is vital in treating them. Virus-induced disseminated intravascular coagulation is uncommon but shares some similarities to sepsis-induced disseminated intravascular coagulation. Marked elevations in hematologic biomarkers such as lactate dehydrogenase, D-dimer, ferritin, and C-reactive protein are associated with worse outcomes. Understanding the pathophysiology and recognizing factors associated with poor prognosis are crucial in improving patient outcomes with coronavirus disease 2019.
新型冠状病毒病由严重急性呼吸综合征冠状病毒 2 引起。它主要感染下呼吸道，现在已知它会引起多系统异常。血液学表现是一个值得关注的重要领域。严重急性呼吸综合征冠状病毒 2 感染单核细胞和内皮细胞，导致复杂的下游级联反应、细胞因子风暴，最终导致血管内血栓形成。新型冠状病毒病会导致淋巴细胞减少、中性粒细胞增多和血小板减少。新型冠状病毒病患者需要预防性抗凝，因为其对凝血系统的影响与较高的发病率和死亡率相关。该疾病可引起动脉和静脉血栓形成，特别是肺栓塞和肺微血栓。高度怀疑是识别这些并发症的必要条件，及时进行治疗性抗凝至关重要。病毒引起的弥散性血管内凝血不常见，但与脓毒症引起的弥散性血管内凝血有一些相似之处。乳酸脱氢酶、D-二聚体、铁蛋白和 C 反应蛋白等血液学生物标志物的显著升高与预后不良相关。了解病理生理学和识别与预后不良相关的因素对于改善新型冠状病毒病患者的预后至关重要。
