Blood clots and lung injuries found in patients who have died of COVID-
19

Date:
August 20, 2020
Source:
Imperial College London
Summary:
A new post-mortem study of patients who have died from COVID-19
found severe damage to the lungs and signs of blood clotting in
major organs.



FULL STORY ==========================================================================
A new post-mortem study of patients who have died from COVID-19 found
severe damage to the lungs and signs of blood clotting in major organs.


==========================================================================
Ten post-mortem examinations performed on patients with confirmed COVID-19 found that all patients had lung injuries and early scarring of the
lungs as a result of the virus, as well as injury to their kidneys. Nine patients also had thrombosis -- a blood clot- in at least one major organ (heart, lung or kidney). The team were unable to investigate thrombosis
in the tenth patient.

The research team behind the study believe that the findings could help
guide clinicians on treating complications as a result of COVID-19, such
as using blood thinners to prevent blood clots from developing. They also
hope that better understanding of the key complications in severe cases
could help clinicians develop new ways to monitor and treat the disease.

The study, published in The Lancet Microbe, was led by researchers
at Imperial College London and Imperial College Healthcare NHS
Trust. Although the numbers of patients examined is small, this is the
largest study to date of post-mortem examinations on COVID-19 patients
in England.

Dr Michael Osborn, Honorary Clinical Senior Lecturer at Imperial College London, Consultant Pathologist at Imperial College Healthcare NHS Trust
and co- author of the study, said: "COVID-19 is a new disease and we have
only had limited opportunities to comprehensively analyse tissues from
patients at autopsy, to better understand what caused a patient's illness
and death for research purposes. Our study is the first of its kind in
the country to support existing theories from researchers and doctors on
the wards that lung injuries, thrombosis and immune cell depletion are
the most prominent features in severe cases of COVID-19. In the patients
we looked at, we also saw evidence of kidney injuries and in some cases pancreatitis and these with our other findings will help clinicians
develop new strategies to manage patients. ??"Autopsy based analysis
of COVID-19 for research is vital to learn more of this disease as the
pandemic develops. We are extremely grateful to those who consented to
this research and appreciate the advancement of medical science their generosity will bring.

As a result of our work, we have worked with colleagues at the Royal
College of Pathologists to produce national guidelines for autopsies in COVID-19 patients and in anticipation of a possible second wave of cases
we have put systems in place to rapidly facilitate further studies in the future and so further our understanding on the nature and cause of the
disease, which we hope would lead to more effective treatments and fewer deaths." Dr Brian Hanley, from the Department of Cellular Pathology at Imperial College Healthcare NHS Trust and co-author of the study, added:


==========================================================================
"The UK has sadly had a large number of deaths related to COVID-19. The
search for effective treatments will rely on an understanding of how
the disease affects the body. The post-mortem examination is vital in
this respect. The findings in this study support research from other
autopsy groups worldwide and in the UK that describe the structural
damage to organs caused by COVID-19. It also documents several unexpected complications. This increased understanding of COVID-19 can help clinical
teams with the management of severe cases and also to monitor and treat
further complications as a result of the disease." During the lockdown
period researchers nationally had very limited opportunities to carry out
post mortem examinations for research purposes on patients who died from
the disease. The team wanted to see whether they can glean new insights
on how the virus infects the cells of the body by studying tissue samples
from patients who died as a result of severe COVID-19.

The team performed full post-mortem examinations and biopsies on ten
patients aged 22-97 at Imperial College Healthcare NHS Trust hospitals
during March- June. Full consent for post mortem with widespread tissue sampling and use of the tissue for research was sought from the relatives
and friends of the deceased in line with national protocols. Seven of
the patients were men and four were women. Six of the patients were from
a BAME background and four patients were white.

In the patients studied, high blood pressure and chronic obstructive
pulmonary disease -- the name for a group of lung conditions that cause breathing difficulties -- were the most common contributing factors to
death. All patients developed a fever and had at least two respiratory
symptoms such as cough and shortness of breath during the early stages
of the disease. Most patients died within three weeks of presenting with symptoms and treatments varied across the cohort.

The study team also reported six main findings:
* All patients had diffuse alveolar damage (DAD). DAD is a term
used to
describe a pattern of lung injury which can be seen as a result
of viral infection. This type of lung injury can affect both gas
exchange (oxygen and carbon dioxide) and blood flood in the lungs.

* All patients fully assessed Nine of the ten patients had some
form of
thrombosis- blood clot -- in at least one major organ (it was not
possible to investigate thrombosis in the tenth patient). Thrombosis
prevents blood from flowing normally through the circulatory system
and can lead to strokes and heart attacks. The researchers found
thrombi in the lungs of eight patients, the heart of five patients
and the kidneys of four patients. They believe that this supports
the theory that COVID- 19 causes circulatory complications and
that patient treatment could be augmented with blood thinning
medication to prevent blood clots
* All patients had evidence of acute renal tubular injury -- a kidney
injury that can lead to kidney failure or damage. The main causes
are low blood flow to the kidneys and severe infections. It often
affects patients who are in hospital and intensive care units
* T-Lymphocyte Depletion (TLD) in the spleen and the lymph nodes was
another consistent finding. T-lymphocytes (white blood cells)
are a major component of the immune system and play a role in
destroying infections.

TLD is a reduction in T-lymphocytes, which alters the immune system
and its response. Haemophagocytosis is another consistent finding
in this group, which occurs when the immune system overreacts to
an infection and destroys some of its own cells
* The researchers found evidence of acute pancreatitis in two of the
patients. Acute pancreatitis is a condition where the pancreas
becomes inflamed. It can be treated with fluids into the veins but
in some cases can develop into serious complications and cause
organ failure. Damage to the pancreas in COVID-19 patients has
not been reported before but it is not clear in this study whether
the pancreatitis was related to COVID-19 infection or other causes
* The researchers also found evidence of a rare fungal infection,
in one of
the patients, called Mucormycosis. Mucormycosis is an infection
that may spread through the bloodstream to affect another part
of the body. Severe infections can involve the lungs, brain and
other organs including the kidneys, spleen and heart.

The team is working with a range of research groups both nationally
and internationally to perform more detailed analyses of these tissues
and is hoping that this research will expand to include a wider range
of patients.

The study was funded by NIHR Imperial College Biomedical Research Centre
(BRC).


========================================================================== Story Source: Materials provided by Imperial_College_London. Original
written by Maxine Myers. Note: Content may be edited for style and length.


========================================================================== Journal Reference:
1. Brian Hanley, Kikkeri N Naresh, Candice Roufosse, Andrew G
Nicholson,
Justin Weir, Graham S Cooke, Mark Thursz, Pinelopi Manousou, Richard
Corbett, Robert Goldin, Safa Al-Sarraj, Alireza Abdolrasouli,
Olivia C Swann, Laury Baillon, Rebecca Penn, Wendy S Barclay,
Patrizia Viola, Michael Osborn. Histopathological findings and viral
tropism in UK patients with severe fatal COVID-19: a post-mortem
study. The Lancet Microbe, 2020; DOI: 10.1016/S2666-5247(20)30115-4 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/08/200820195357.htm

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