Megakaryocytes and platelet-fibrin thrombi characterize multi-organ thrombosis at autopsy in COVID-19: A case series
Megakaryocytes and platelet-fibrin thrombi characterize multi-organ thrombosis at autopsy in COVID-19: A case series
复制标题
DOI：
10.1016/j.eclinm.2020.100434
复制
发表时间：
2020-07-01
影响因子：
15.1
通讯作者：
Reynolds, Harmony R.
中科院分区：
文献类型：
--
作者：
Rapkiewicz, Amy, V;Mai, Xingchen;Reynolds, Harmony R.
背景：人们越来越认识到 COVID-19 中存在血栓前状态。尸检可以提供重要的机制见解。方法：我们提出了来自纽约学术医疗中心的 COVID-19 尸检系列，包括肺、心脏、肾脏、肝脏和骨骼的发现。结果：在 7 名患者（四名女性）中，无论抗凝状态如何，所有尸检均显示肺、肝、肾和心脏微血管中存在富含血小板的血栓。肺和心脏中巨核细胞的数量高于平常。两例肺大动脉有血栓，铸型符合解剖位置。未发现下腔静脉血栓，但未解剖腿部深静脉。 2例存在心脏静脉血栓，1例表现为间隔性心肌梗死伴心肌内静脉血栓，无动脉粥样硬化。 1 例心肌出现局灶性急性淋巴细胞为主的炎症，但心肌细胞内未发现病毒颗粒。除此之外，心脏组织病理学变化仅限于轻微的心外膜炎症（n = 1）、早期缺血性损伤（n = 3）和附壁纤维蛋白血栓（n = 2）。富含血小板的肾小管周围纤维蛋白微血栓是一个显着的肾脏特征。多例可见急性肾小管坏死、红细胞及颗粒管型。明显不存在显着的肾小球病理学。在肝窦中发现了许多血小板纤维蛋白微血栓。所有肺部均表现出弥漫性肺泡损伤（DAD），伴有一系列渗出和增殖期，包括透明膜和肺细胞增生，上皮细胞和巨噬细胞中存在病毒包涵体。 3 例合并急性支气管肺炎，局灶性坏死。 解读：在这一系列的 7 例 COVID-19 尸检中，血栓形成是多个器官的一个突出特征，在某些病例中，尽管进行了充分的抗凝治疗，并且无论病程的时间如何，这表明血栓形成在疾病过程的早期就发挥了作用。在肺、心脏和肾脏中发现巨核细胞和富含血小板的血栓表明其在血栓形成中发挥作用。 (C) 2020 年由爱思唯尔有限公司出版。
Background: There is increasing recognition of a prothrombotic state in COVID-19. Post-mortem examination can provide important mechanistic insights.Methods: We present a COVID-19 autopsy series including findings in lungs, heart, kidneys, liver, and bone, from a New York academic medical center.Findings: In seven patients (four female), regardless of anticoagulation status, all autopsies demonstrated platelet-rich thrombi in the pulmonary, hepatic, renal, and cardiac microvasculature. Megakaryocytes were seen in higher than usual numbers in the lungs and heart. Two cases had thrombi in the large pulmonary arteries, where casts conformed to the anatomic location. Thrombi in the IVC were not found, but the deep leg veins were not dissected. Two cases had cardiac venous thrombosis with one case exhibiting septal myocardial infarction associated with intramyocardial venous thrombosis, without atherosclerosis. One case had focal acute lymphocyte-predominant inflammation in the myocardium with no virions found in cardiomyocytes. Otherwise, cardiac histopathological changes were limited to minimal epicardial inflammation (n = 1), early ischemic injury (n = 3), and mural fibrin thrombi (n = 2). Platelet-rich peri-tubular fibrin microthrombi were a prominent renal feature. Acute tubular necrosis, and red blood cell and granular casts were seen in multiple cases. Significant glomerular pathology was notably absent. Numerous platelet-fibrin microthrombi were identified in hepatic sinusoids. All lungs exhibited diffuse alveolar damage (DAD) with a spectrum of exudative and proliferative phases including hyaline membranes, and pneumocyte hyperplasia, with viral inclusions in epithelial cells and macrophages. Three cases had superimposed acute bronchopneumonia, focally necrotizing.Interpretation: In this series of seven COVID-19 autopsies, thrombosis was a prominent feature in multiple organs, in some cases despite full anticoagulation and regardless of timing of the disease course, suggesting that thrombosis plays a role very early in the disease process. The finding of megakaryocytes and platelet-rich thrombi in the lungs, heart and kidneys suggests a role in thrombosis. (C) 2020 Published by Elsevier Ltd.