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Blood Clots, Lung Injuries Found In Patients Who Have Died Of COVID-19: Study

The research team behind the study, published in The Lancet Microbe, 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

Blood Clots, Lung Injuries Found In Patients Who Have Died Of COVID-19: Study
Highlights
  • In the study, ten post-mortem exams were performed on COVID-19 patients
  • All COVID patients assessed had blood clot in at least one major organs
  • All patients had kidney injury that can lead to kidney failure or damage

Washington D.C.: 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 was 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 a 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 number 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.

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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 about 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 monitor and treat further complications as a result of the disease.

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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.

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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- a 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.

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-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 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.

(Except for the headline, this story has not been edited by NDTV staff and is published from a syndicated feed.)

NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (WaterSanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollutionwaste managementplastic banmanual scavenging and sanitation workers and menstrual hygiene

World

24,00,62,413Cases
20,17,73,183Active
3,33,99,961Recovered
48,89,269Deaths
Coronavirus has spread to 195 countries. The total confirmed cases worldwide are 24,00,62,413 and 48,89,269 have died; 20,17,73,183 are active cases and 3,33,99,961 have recovered as on October 16, 2021 at 4:08 am.

India

3,40,53,573 15,981Cases
2,01,6322,046Active
3,33,99,961 17,861Recovered
4,51,980 166Deaths
In India, there are 3,40,53,573 confirmed cases including 4,51,980 deaths. The number of active cases is 2,01,632 and 3,33,99,961 have recovered as on October 16, 2021 at 2:30 am.

State Details

State Cases Active Recovered Deaths
Maharashtra

65,88,429 2,149

33,379 222

64,15,316 1,898

1,39,734 29

Kerala

48,38,811 8,867

95,349 1,072

47,16,728 9,872

26,734 67

Karnataka

29,82,869 470

9,700 93

29,35,238 368

37,931 9

Tamil Nadu

26,84,641 1,245

15,238 213

26,33,534 1,442

35,869 16

Andhra Pradesh

20,59,708 586

6,453 135

20,38,960 712

14,295 9

Uttar Pradesh

17,10,014 6

133 2

16,86,984 8

22,897

West Bengal

15,79,463 451

7,513 63

15,52,997 506

18,953 8

Delhi

14,39,337 26

327 10

14,13,921 36

25,089

Odisha

10,34,276 467

4,817 73

10,21,180 535

8,279 5

Chhattisgarh

10,05,624 10

197 6

9,91,857 16

13,570

Rajasthan

9,54,383 1

40 2

9,45,389 3

8,954

Gujarat

8,26,258 14

212 3

8,15,960 17

10,086

Madhya Pradesh

7,92,675 6

106 5

7,82,046 11

10,523

Haryana

7,71,049 14

116 11

7,60,884 3

10,049

Bihar

7,26,021 5

46 4

7,16,314 1

9,661

Telangana

6,68,722 104

4,056 115

6,60,730 218

3,936 1

Assam

6,05,944 97

3,458 188

5,96,547 284

5,939 1

Punjab

6,01,992 21

228 6

5,85,224 25

16,540 2

Jharkhand

3,48,415 9

130 0

3,43,150 9

5,135

Uttarakhand

3,43,739 10

179 4

3,36,163 6

7,397

Jammu And Kashmir

3,30,885 51

895 40

3,25,564 91

4,426

Himachal Pradesh

2,21,203 90

1,361 26

2,16,125 114

3,717 2

Goa

1,77,410 54

648 31

1,73,423 81

3,339 4

Puducherry

1,27,296 37

611 36

1,24,836 73

1,849

Manipur

1,22,545 113

1,444 0

1,19,208 109

1,893 4

Mizoram

1,11,651 932

13,316 285

97,955 1,211

380 6

Tripura

84,299 4

102 8

83,381 12

816

Meghalaya

82,815 81

893 1

80,490 79

1,432 1

Chandigarh

65,297 2

30 2

64,447 4

820

Arunachal Pradesh

54,964 6

183 19

54,501 25

280

Sikkim

31,739 17

189 35

31,159 51

391 1

Nagaland

31,547 31

228 2

30,645 32

674 1

Ladakh

20,871 4

42 2

20,621 6

208

Dadra And Nagar Haveli

10,675

3 0

10,668

4

Lakshadweep

10,365

1 1

10,313 1

51

Andaman And Nicobar Islands

7,641 1

9 1

7,503 2

129

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