Abnormal coagulation status
Patients 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].
Figure 1. Ecchymosis in severe type of COVID-19 patients.