The Agreed Experts’ Position of the Eurasian Association of Therapists on Some new Mechanisms of COVID-19 Pathways: Focus on Hemostasis, Hemotransfusion Issues and Blood gas Exchange
https://doi.org/10.18087/cardio.2020.5.n1132
Abstract
The article discusses pathogenesis and treatment of COVID-19. The authors presented state-of-the-art insight into hemostatic disorders in patients with COVID-19 and clinical recommendations on prevention of thrombosis and thromboembolism in patients infected with SARS-CoV-2. The article discussed in detail a new hypothesis proposed by Chinese physicians about a new component in the pathogenesis of COVID-19, namely, about the effect of SARS-CoV-2 virus on the hemoglobin beta-chain and the formation of a complex with porphyrin, which results in displacement of the iron ion. Thus, hemoglobin loses the capability for transporting oxygen, which aggravates hypoxia and worsens the prognosis. The article stated rules of hemotransfusion safety in the conditions of COVID-19 pandemic.
About the Authors
G. P. ArutyunovRussian Federation
MD, Corresponding Member of the Russian Academy of Sciences, Head of the Department of Internal Medicine and General Physiotherapy, Federal State Autonomous Educational Institution of Higher Education N.I. Pirogova, Moscow
N. A. Koziolova
Russian Federation
MD, professor, head of the Department of Internal Diseases, Federal State Budgetary Educational Establishment of Higher Education Perm Medical University named after Acad. E.A. Wagner, Perm
E. I. Tarlovskaya
Russian Federation
MD, professor, head of the Department of Therapy and Cardiology, FSBEI HE PIMU, Nizhny Novgorod
A. G. Arutyunov
Russian Federation
MD, associate professor, professor of the Department of Internal Medicine and General Physiotherapy, Federal State Autonomous Educational Establishment of Higher Educational Institution named after N.I. Pirogova, Moscow
N. Yu. Grigorjeva
Russian Federation
MD, Associate Professor, Head of the Department of Faculty and Outpatient Therapy, FSBEI HE PIMU of the Ministry of Health of Russia, Nizhny Novgorod
G. A. Dzhunusbekova
Kazakhstan
MD, Professor, Head of the Department of Cardiology of the Kazakh Medical University of Postgraduate Education, Almaty, Republic of Kazakhstan
S. V. Malchikova
Russian Federation
MD, Associate Professor, Professor, Department of Hospital Therapy, FSBEI HE Kirov State Medical University, Kirov
N. P. Mitkovskaya
Belarus
MD, Professor, Head of the Department of Cardiology and Internal Medicine of the Belarusian State Medical University, Minsk, Republic of Belarus
Ya. A. Orlova
Russian Federation
Md,l Sciences, Professor, Head of the Department of Therapy, Faculty of Fundamental Medicine, Moscow State University Lomonosov Moscow
M. M. Petrova
Russian Federation
MD, professor, head of the department of outpatient therapy, family medicine and healthy lifestyle with a course in Krasnoyarsk State Medical University named after professors V.F. War-Yasenetsky, Krasnoyarsk
A. P. Rebrov
Russian Federation
MD, Professor, Head of the Department of Hospital Therapy, Saratov State Medical University named after IN AND. Razumovsky, Saratov
A. S. Sisakyan
Armenia
MD, Professor, Head of the Department of Cardiology, Faculty of General Medicine, Yerevan State Medical University, Yerevan, Republic of Armenia
V. V. Skibitsky
Russian Federation
MD, professor Head of the Department of Hospital Therapy, Federal State Budgetary Educational Institution of Higher Education Kuban State Medical University, Krasnodar
A. B. Sugraliev
Kazakhstan
Phd, associate professor, head of the department of internal diseases No. 1 of the Kazakh National Medical University named after S.D. Asfendiyarova, Almaty, Republic of Kazakhstan
I. V. Fomin
Russian Federation
MD, Associate Professor, Head of the Department of Hospital Therapy, FSBEI HE PIMU, Nizhny Novgorod
A. I. Chesnikova
Russian Federation
MD, professor, professor of the Department of Internal Medicine No. 1 of FSBEI HE Rostov State Medical University, Rostov-on-Don
I. I. Shaposhnik
Russian Federation
MD, Professor, Head of the Department of Propaedeutics of Internal Diseases FSBEI HE South Ural State Medical University, Chelyabinsk
References
1. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The Lancet. 2020;395(10223):507–13. DOI: 10.1016/S0140-6736(20)30211-7
2. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet. 2020;395(10223):497–506. DOI: 10.1016/S0140-6736(20)30183-5
3. Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. Journal of Thrombosis and Haemostasis. 2020;18(4):844–7. DOI: 10.1111/jth.14768
4. Xie Y, Wang X, Yang P, Zhang S. COVID-19 Complicated by Acute Pulmonary Embolism. Radiology: Cardiothoracic Imaging. 2020;2(2):e200067. DOI: 10.1148/ryct.2020200067
5. Danzi GB, Loffi M, Galeazzi G, Gherbesi E. Acute pulmonary embolism and COVID-19 pneumonia: a random association? European Heart Journal. 2020;ehaa254. [Epub ahead of print]. DOI: 10.1093/eurheartj/ehaa254
6. Li T, Lu H, Zhang W. Clinical observation and management of COVID-19 patients. Emerging Microbes & Infections. 2020;9(1):687–90. DOI: 10.1080/22221751.2020.1741327
7. Schmitt FCF, Manolov V, Morgenstern J, Fleming T, Heitmeier S, Uhle F et al. Acute fibrinolysis shutdown occurs early in septic shock and is associated with increased morbidity and mortality: results of an observational pilot study. Annals of Intensive Care. 2019;9(1):19. DOI: 10.1186/s13613-019-0499-6
8. Thachil J, Tang N, Gando S, Falanga A, Cattaneo M, Levi M et al. ISTH interim guidance on recognition and management of coagulopathy in COVID‐19. Journal of Thrombosis and Haemostasis. 2020;jth.14810. [Epub ahead of print]. DOI: 10.1111/jth.14810
9. Fung S-Y, Yuen K-S, Ye Z-W, Chan C-P, Jin D-Y. A tug-of-war between severe acute respiratory syndrome coronavirus 2 and host antiviral defence: lessons from other pathogenic viruses. Emerging Microbes & Infections. 2020;9(1):558–70. DOI: 10.1080/22221751.2020.1736644
10. Schultz MJ, Haitsma JJ, Zhang H, Slutsky AS. Pulmonary coagulopathy as a new target in therapeutic studies of acute lung injury or pneumonia - a review. Critical Care Medicine. 2006;34(3):871–7. DOI: 10.1097/01.CCM.0000201882.23917.B8
11. Evans CE. Hypoxia and HIF activation as a possible link between sepsis and thrombosis. Thrombosis Journal. 2019;17(1):16. DOI: 10.1186/s12959-019-0205-9
12. Yin S, Huang M, Li D, Tang N. Difference of coagulation features between severe pneumonia induced by SARS-CoV-2 and non-SARSCoV-2. Journal of Thrombosis and Thrombolysis. 2020; [Epub ahead of print]. DOI: 10.1007/s11239-020-02105-8
13. Guo T, Fan Y, Chen M, Wu X, Zhang L, He T et al. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). JAMA Cardiology. 2020; [Epub ahead of print]. DOI: 10.1001/jamacardio.2020.1017
14. Chen G, Wu D, Guo W, Cao Y, Huang D, Wang H et al. Clinical and immunological features of severe and moderate coronavirus disease 2019. Journal of Clinical Investigation. 2020;137244. [Epub ahead of print]. DOI: 10.1172/JCI137244
15. Ning Tang. Coagulation tests In COVID -19. Av. at: https://academy.isth.org/pdfviewer/web/viewer.html?file=https%3A//academy.isth.org/isth/2020/covid-19/document%3Fc_id%3D290512%26type%3Djournal_article.
16. Guan W, Ni Z, Hu Y, Liang W, Ou C, He J et al. Clinical Characteristics of Coronavirus Disease 2019 in China. New England Journal of Medicine. 2020; [Epub ahead of print]. DOI: 10.1056/NEJMoa2002032
17. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061–9. DOI: 10.1001/jama.2020.1585
18. Ministry of Health of Russian Federation. Temporary guidelines of the Ministry of health of the Russian Federation “Prevention, diagnosis and treatment of new coronavirus infection (COVID-19)”. Version 5 of 08.04.2020. Moscow. Av. at: https://static-1.rosminzdrav.ru/system/attachments/attaches/000/049/951/original/09042020_%D0%9C%D0%A0_COVID-19_v5.pdf?fbclid=IwAR0PLbz6taMKt4QZy7yXbdnYJFYhkr5pDOkLNFdKoEyfkoPa-Phy2syXNo. 2020.
19. Hunt B, Retter A, McClintock C. Practical guidance for the prevention of thrombosis and management of coagulopathy and disseminated intravascular coagulation of patients infected with COVID-19. Av. at: https://thrombosisuk.org/downloads/T&H%20and%20COVID.pdf. 2020.
20. Moore HB, Barrett CD, Moore EE, McIntyre RC, Moore PK, Talmor DS et al. Is there a role for tissue plasminogen activator as a novel treatment for refractory COVID-19 associated acute respiratory distress syndrome?: Journal of Trauma and Acute Care Surgery. 2020; [Epub ahead of print]. DOI: 10.1097/TA.0000000000002694
21. Tian S, Hu W, Niu L, Liu H, Xu H, Xiao S-Y. Pulmonary Pathology of Early-Phase 2019 Novel Coronavirus (COVID-19) Pneumonia in Two Patients With Lung Cancer. Journal of Thoracic Oncology. 2020;15(5):700–4. DOI: 10.1016/j.jtho.2020.02.010
22. Liu C, Ma Y, Su Z, Zhao R, Zhao X, Nie H-G et al. Meta-Analysis of Preclinical Studies of Fibrinolytic Therapy for Acute Lung Injury. Frontiers in Immunology. 2018;9:1898. DOI: 10.3389/fimmu.2018.01898
23. Hardaway RM, Harke H, Tyroch AH, Williams CH, Vazquez Y, Krause GF. Treatment of severe acute respiratory distress syndrome: a final report on a phase I study. The American Surgeon. 2001;67(4):377–82. PMID: 11308009
24. The Liverpool Drug Interaction Group. Liverpool COVID-19 Interactions. Detailed recommendations for interactions with experimental COVID-19 therapies. 2020. [Internet] Available at: https://www.covid19-druginteractions.org/
25. Chang L, Yan Y, Wang L. Coronavirus Disease 2019: Coronaviruses and Blood Safety. Transfusion Medicine Reviews. 2020; [Epub ahead of print]. DOI: 10.1016/j.tmrv.2020.02.003
26. Ng EKO, Ng P-C, Hon KLE, Cheng WTF, Hung ECW, Chan KCA et al. Serial Analysis of the Plasma Concentration of SARS Coronavirus RNA in Pediatric Patients with Severe Acute Respiratory Syndrome. Clinical Chemistry. 2003;49(12):2085–8. DOI: 10.1373/clinchem.2003.024588
27. Ng EKO, Hui DS, Chan KCA, Hung ECW, Chiu RWK, Lee N et al. Quantitative Analysis and Prognostic Implication of SARS Coronavirus RNA in the Plasma and Serum of Patients with Severe Acute Respiratory Syndrome. Clinical Chemistry. 2003;49(12):1976–80. DOI: 10.1373/clinchem.2003.024125
28. Grant PR, Garson JA, Tedder RS, Chan PKS, Tam JS, Sung JJY. Detection of SARS Coronavirus in Plasma by Real-Time RT-PCR. New England Journal of Medicine. 2003;349(25):2468–9. DOI: 10.1056/NEJM200312183492522
29. Drosten C, Günther S, Preiser W, van der Werf S, Brodt H-R, Becker S et al. Identification of a Novel Coronavirus in Patients with Severe Acute Respiratory Syndrome. New England Journal of Medicine. 2003;348(20):1967–76. DOI: 10.1056/NEJMoa030747
30. Corman VM, Albarrak AM, Omrani AS, Albarrak MM, Farah ME, Almasri M et al. Viral Shedding and Antibody Response in 37 Patients With Middle East Respiratory Syndrome Coronavirus Infection. Clinical Infectious Diseases. 2016;62(4):477–83. DOI: 10.1093/cid/civ951
31. World Health Organization. WHO Recommendations on SARS and Blood Safety. 2003. [Internet] Available at: https://www.who.int/csr/sars/guidelines/bloodsafety/en/
32. FDA. Revised recommendations for the assessment of donor suitability and blood product safety in cases of suspected severe acute respiratory syndrome (SARS) or exposure to SARS: guidance for industry. Av. at: https://www.fda.gov/media/124354/download. 2003.
33. Wang H, Mao Y, Ju L, Zhang J, Liu Z, Zhou X et al. Detection and Monitoring of SARS Coronavirus in the Plasma and Peripheral Blood Lymphocytes of Patients with Severe Acute Respiratory Syndrome. Clinical Chemistry. 2004;50(7):1237–40. DOI: 10.1373/clinchem.2004.031237
34. Li L, Wo J, Shao J, Zhu H, Wu N, Li M et al. SARS-coronavirus replicates in mononuclear cells of peripheral blood (PBMCs) from SARS patients. Journal of Clinical Virology. 2003;28(3):239–44. DOI: 10.1016/S1386-6532(03)00195-1
35. Yilla M, Harcourt BH, Hickman CJ, McGrew M, Tamin A, Goldsmith CS et al. SARS-coronavirus replication in human peripheral monocytes/macrophages. Virus Research. 2005;107(1):93–101. DOI: 10.1016/j.virusres.2004.09.004
36. Law HKW, Cheung CY, Ng HY, Sia SF, Chan YO, Luk W et al. Chemokine up-regulation in SARS-coronavirus–infected, monocyte-derived human dendritic cells. Blood. 2005;106(7):2366–74. DOI: 10.1182/blood-2004-10-4166
37. Schmidt M, Brixner V, Ruster B, Hourfar MK, Drosten C, Preiser W et al. NAT screening of blood donors for severe acute respiratory syndrome coronavirus can potentially prevent transfusion associated transmissions. Transfusion. 2004;44(4):470–5. DOI: 10.1111/j.1537-2995.2004.03269.x
38. Cheng PK, Wong DA, Tong LK, Ip S-M, Lo AC, Lau C-S et al. Viral shedding patterns of coronavirus in patients with probable severe acute respiratory syndrome. The Lancet. 2004;363(9422):1699–700. DOI: 10.1016/S0140-6736(04)16255-7
39. Hung IFN, Cheng VCC, Wu AKL, Tang BSF, Chan KH, Chu CM et al. Viral Loads in Clinical Specimens and SARS Manifestations. Emerging Infectious Diseases. 2004;10(9):1550–7. DOI: 10.3201/eid1009.040058
40. Poon TCW, Chan KCA, Ng P-C, Chiu RWK, Ang IL, Tong Y et al. Serial Analysis of Plasma Proteomic Signatures in Pediatric Patients with Severe Acute Respiratory Syndrome and Correlation with Viral Load. Clinical Chemistry. 2004;50(8):1452–5. DOI: 10.1373/clinchem.2004.035352
41. European Centre for Disease Prevention and Control. Rapid Risk Assessment: Outbreak of acute respiratory syndrome associated with a novel coronavirus, Wuhan, China; first update. Av. at: https://www.ecdc.europa.eu/sites/default/files/documents/Risk-assessmentpneumonia-Wuhan-China-22-Jan-2020.pdf. 2020.
42. American Association of Blood Banks. Update: impact of 2019 novel coronavirus and blood safety. Av. at: http://www.aabb.org/advocacy/regulatorygovernment/Documents/Impact-of-2019-Novel-Coronavirus-on-Blood-Donation.pdf. 2020.
43. Chinese Society of Blood Transfusion. Recommendations on blood collection and supply during the epidemic of novel coronavirus pneumonia in China, 1st edition [in Chinese]. Av. at: https://www.csbt.org.cn/plus/view.php?aid=16530. 2020.
44. Zhai P, Ding Y, Wu X, Long J, Zhong Y, Li Y. The epidemiology, diagnosis and treatment of COVID-19. International Journal of Antimicrobial Agents. 2020;105955. [Epub ahead of print]. DOI: 10.1016/j.ijantimicag.2020.105955
45. Luan J, Lu Y, Jin X, Zhang L. Spike protein recognition of mammalian ACE2 predicts the host range and an optimized ACE2 for SARSCoV-2 infection. Biochemical and Biophysical Research Communications. 2020;526(1):165–9. DOI: 10.1016/j.bbrc.2020.03.047
46. Rizzo P, Vieceli Dalla Sega F, Fortini F, Marracino L, Rapezzi C, Ferrari R. COVID-19 in the heart and the lungs: could we ‘Notch’ the inflammatory storm? Basic Research in Cardiology. 2020;115(3):31. DOI: 10.1007/s00395-020-0791-5
47. Liu W, Li H. COVID-19: Attacks the 1-Beta Chain of Hemoglobin and Captures the Porphyrin to Inhibit Human Heme Metabolism. Av. at: https://chemrxiv.org/articles/COVID-19_Disease_ORF8_and_Surface_Glycoprotein_Inhibit_Heme_Metabolism_by_Binding_to_Porphyrin/11938173/7. 2020.
48. Wikipedia. Cross-sectional model of a coronavirus. Av. at: https://en.wikipedia.org/wiki/Coronavirus#/media/File:3D_medical_animation_coronavirus_structure.jpg.
49. Biochemistry for students. Hemoglobin – the main protein of blood. Av. at: http://biokhimija.ru/hemoglobin/obmen-gemoglobina.html.
50. Li H, Liu S-M, Yu X-H, Tang S-L, Tang C-K. Coronavirus disease 2019 (COVID-19): current status and future perspectives. International Journal of Antimicrobial Agents. 2020;105951. [Epub ahead of print]. DOI: 10.1016/j.ijantimicag.2020.105951
51. Coronavirus 2019-nCoV and COVID-19. Av. at: https://www.tehpodderzka.ru/2020/02/2019-nCoV.html. 2020.
52. Shereen MA, Khan S, Kazmi A, Bashir N, Siddique R. COVID-19 infection: Origin, transmission, and characteristics of human coronaviruses. Journal of Advanced Research. 2020;24:91–8. DOI: 10.1016/j.jare.2020.03.005
53. IDSA Practice Guidelines. COVID-19 Guideline. Av. at: https://www.idsociety.org/practice-guideline/practice-guidelines/#/date_na_dt/DESC/0/+/. 2020.
54. CDC. Coronavirus Disease 2019 (COVID-19). 2020. [Internet] Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html
55. Devaux CA, Rolain J-M, Colson P, Raoult D. New insights on the antiviral effects of chloroquine against coronavirus: what to expect for COVID-19? International Journal of Antimicrobial Agents. 2020;105938. [Epub ahead of print]. DOI: 10.1016/j.ijantimicag.2020.105938
56. Onder G, Rezza G, Brusaferro S. Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy. JAMA. 2020; [Epub ahead of print]. DOI: 10.1001/jama.2020.4683
57. Wang M, Cao R, Zhang L, Yang X, Liu J, Xu M et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Research. 2020;30(3):269–71. DOI: 10.1038/s41422-020-0282-0
Review
For citations:
Arutyunov G.P., Koziolova N.A., Tarlovskaya E.I., Arutyunov A.G., Grigorjeva N.Yu., Dzhunusbekova G.A., Malchikova S.V., Mitkovskaya N.P., Orlova Ya.A., Petrova M.M., Rebrov A.P., Sisakyan A.S., Skibitsky V.V., Sugraliev A.B., Fomin I.V., Chesnikova A.I., Shaposhnik I.I. The Agreed Experts’ Position of the Eurasian Association of Therapists on Some new Mechanisms of COVID-19 Pathways: Focus on Hemostasis, Hemotransfusion Issues and Blood gas Exchange. Kardiologiia. 2020;60(5):9-19. (In Russ.) https://doi.org/10.18087/cardio.2020.5.n1132