A mysterious blood-clotting complication is killing coronavirus patients

[Right_in_Virginia]

A mysterious blood-clotting complication is killing coronavirus patients
Washington Post, Apr 23, 2020

<snip>

Autopsies have shown some people’s lungs fill with hundreds of microclots. Errant blood clots of a larger size can break off and travel to the brain or heart, causing a stroke or heart attack. On Saturday, Broadway actor Nick Cordero, 41, had his right leg amputated after being infected with the novel coronavirus and suffering from clots that blocked blood from getting to his toes.

Lewis Kaplan, a University of Pennsylvania physician and head of the Society of Critical Care Medicine, said every year doctors treat people with clotting complications, from those with cancer to victims of severe trauma, “and they don’t clot like this.”

“The problem we are having is that while we understand that there is a clot, we don’t yet understand why there is a clot,” Kaplan said. “We don’t know. And therefore, we are scared.”

[...]

Harlan Krumholz, a cardiac specialist at the Yale-New Haven Hospital Center, said no one knows whether blood complications are a result of a direct assault on blood vessels, or a hyperactive inflammatory response to the virus by the patient’s immune system.

“One of the theories is that once the body is so engaged in a fight against an invader, the body starts consuming the clotting factors, which can result in either blood clots or bleeding. In Ebola, the balance was more toward bleeding. In covid-19, it’s more blood clots,” he said.

A study published in JAMA on Wednesday found that a large number of covid-19 patients admitted to New York State’s largest health system came in with blood test readings that indicated clotting problems.

And a Dutch study published April 10 in the journal Thrombosis Research provided more evidence the issue is widespread, finding 38 percent of 184 covid-19 patients in an intensive care unit had blood that clotted abnormally. The researchers called it “a conservative estimation” because many of the patients were still hospitalized and at risk of further complications.



More:  https://www.washingtonpost.com/health/2020/04/22/coronavirus-blood-clots/

[Smokin Joe]

Cytokines as Regulators of Coagulation

https://www.ncbi.nlm.nih.gov/books/NBK6207/

This may be related to cytokine response, and Tissue Necrosis Factor.

The study indicates that increased tissue necrosis factor (TNF) induces a rise in is prothrombin F1+2, which is part of the reaction that eventually forms a clot.

My theory is that: Localized increases in TNF due to preexisting circulatory issues or tissue swelling from inflammation (compartment syndrome type behaviour) keeping the TNF from becoming more widely dispersed may cause small scale localized clotting as part of or a result of the Cytokine response. Just an idea from an old rockhound, (I'm not a microbiologist). 

Additionally, this would fit with people who had a history of circulatory problems, including high blood pressure and coronary disease, because the amount of constriction necessary to lodge a clot, or to keep the TNF from becoming more dispersed would be less.