Covid 19 making sense of the literature

Summary of findings of post-mortem reports in patients with COVID-19 – June 2020

Recently published autopsy series highlighted pulmonary arterial thrombosis as one of the key findings in severe lung injury caused by Covid 19
Complete autopsies were performed in accordance with the standard international guidelines with the use of proper PPE And donning-doffing precautions .All cases were confirmed sarCov2 by RT PCR on nasopharyngeal swabs.
One of the scientists from Brazil used minimally invasive ultrasound autopsy which is a suitable autopsy in such infected patients.
Another scientist in the US compare the long findings from autopsies of COVID-19 patients with those obtained from patients who died of ARDS secondary to influenza A H1N1 infection and age matched an infected control lungs.

Results

All cases showed varying degree of Exudative/plot of proliferative diffuse alveolar damage classical of ARDS

Of note fibrin thrombi observed in small and mid-sized arteries in a high proportion of cases in all the cited studies.
Associated changes of
pulmonary embolism
infarction
endothelial damage
and angiogenesis
were also observed.

There was no evidence of thromboembolism in the central vessels at autopsy or prior to death in any of the cases.
Compared with influenza lungs, Covid 19 lungs had a nine fold more pulmonary alveolar capillary thrombosis and 2.7 times more angiogenesis.
Endothelial cell injury with intra cellular source COV2 was observed.
Moreover 69 angiogenesis related genes were seen as differentially regulated in the Covid 19 lungs compared with 26 genes in the influenza lungs.

Conclusion

Vascular and thrombotic events play a role as drivers of pathological changes leading to severe lung injury and death in COVID-19.


Strengths of the test
Few of the first series on pulmonary autopsy findings in COVID-19 which highlight the thrombotic and vascular changes in the small arteries.

Weakness of the test
Small number of cases studied
Limited data on effect on other organs


Opinion

Autopsies or gold standard to identify the cause of death and study the pathophysiology of novel diseases.
Though the studies are less as compare to number of deaths worldwide findings of pulmonary artery thrombosis and thromboembolism in the studies underpin and parallel the recent findings of Quaglia Pati induced complications and potential benefit of anticoagulants in the treatment of severe Covid 19.

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