PMC:7103696 / 2319-5484 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7103696","sourcedb":"PMC","sourceid":"7103696","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7103696","text":"Professor Taisheng Li (being sent to Wuhan from Beijing to provide frontline care to the COVID-19 cases in a local hospital)\nSince 7 February 2020, my colleagues and I went to work in the intensive care unit (ICU) of Zhongfa Xincheng Hospital, part of Tongji Hospital in Wuhan. Although the case fatality rate of COVID-19 is not high, due to the widespread of the disease, the total number of deaths is not small. Based on my observations in the treatment of severe and critically ill patients in the ICU, I propose that the early intravenous immunoglobulin (IVIG) and low molecular weight heparin (LMWH) anticoagulation therapy are very important.\n\nClinical course of COVID-19\nWhen SARS-CoV-2 infects a person, the lesions are not limited to the lungs. The virus causes viraemia after entering the body and the main clinical manifestations are fever, pharyngalgia, fatigue, diarrhoea and other non-specific symptoms [3,4]. This process includes the incubation phase and the early phase of the disease. The incubation takes 1–14 days (3–7 days being common). Peripheral blood leucocytes and lymphocytes are not significantly reduced (normal or slightly lower) at this phase. Then, the viruses spread through the bloodstream and mainly in the lungs, gastrointestinal tract, and heart, presumably concentrated in the tissues expressing ACE2, the receptor of SARS-CoV-2. This phase occurs around 7–14 after the onset of the symptoms when the virus starts a second attack, which is also the main cause of the aggravation of symptoms. At this time, pulmonary lesions became worse, and chest CT scans show imaging changes consistent with COVID-19. At this stage, the peripheral blood lymphocytes decrease significantly, involving both T and B lymphocytes. Inflammatory factors in peripheral blood are increased.\n\nAbnormal coagulation status\nPatients at this phase will begin to develop the hypercoagulable state and D-Dimer-based coagulation factors may appear abnormal. The use of IVIG at this time may provide patients with effective clinical benefits and inhibit the formation of inflammatory factors storm (“cytokine storm”). LWMH therapy, suggested by colleagues at the Department of Hematology, Peking Union Medical College Hospital, may also alleviate the hypercoagulable state in patients. During the development of dyspnoea and chest imaging changes from light to severe, the D-dimer increased from mild to significant, along with prolonged prothrombin time (PT) and gradual decrease of fibrinogen (FBG) and platelet. Recently, it has been observed that some of the non-survivors suffered from ischaemic changes such as ecchymosis of the fingers and toes (Figure 1), at the same time as the organ functions of the heart and kidneys became worse. The above manifestations are consistent with the diagnosis of the hypercoagulable phase of DIC. It is believed that COVID-2019 can activate coagulation cascade through various mechanisms, leading to severe hypercoagulability. Early anticoagulation may block clotting formation and reduce microthrombus, thereby reducing the risk of major organ damages [5,6].\nFigure 1. Ecchymosis in severe type of COVID-19 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