Journal of Blood & Lymph

The COVID-19 pandemic has claimed over 1 million lives globally and results from the SARS-CoV-2 virus. COVID-19 is associated with a coagulopathy. In this mixed-methods PRISMA-compliant scoping review, we set out to determine if ARDS, sepsis and DIC could account for the coagulopathy and if there were any other features of the coagulopathy we could determine so as to inform future research. Methods: We used a search strategy to identify papers with clinically relevant thromboembolic events in COVID-19. We then developed a technique referred to as an Abridged Thematic Analysis (ATA) to quickly identify themes in the papers so as to increase the yield of clinically relevant information. We further developed Validated Abridged Thematic Analysis (VATA) to validate the resulting taxonomy of themes. Finally we developed a number of methods that can be used by other researchers to take forwards this work. Results: We identified 56 studies with 10,523 patients, 456 patients with COVID-19 and Thromboembolic Events (TBE’s) and 586 thrombembolic events. There was an average of 1.3 TBE’s per patient. There were five main arterial territories with corresponding clinical sequelae: Acute limb ischaemia, myocardial infarcts, strokes, mesenteric ischaemia and pulmonary embolism. We also identified DVT’s. There were two further groups: medical-device-related coagulopathy and dermal lesions. In a subgroup of 119 patients we found mortality ranged from 26% in DVT to 79% in acute limb ischaemia although there was evidence of selection bias in the latter group. All patients were hospitalised and the average age of survivors was 63 versus 73 for those who died. 91/150 patients with TE’s had fever. From the ATA, we identified 16 characteristics of the clotting pathology in COVID-19. From the VATA, we identified 34 mechanisms leading to coagulopathy and grouped them according to Virchow’s triad of vascular damage, stasis and hypercoagulability. Coagulopathy occurred with and without each of ARDS, Sepsis and DIC. We conclude that COVID-19 leads to the syndrome of a viral clotting fever in a subgroup of patients and that the presentation of coagulopathy and fever should raise the possibility of COVID-19 as a differential. We make recommendations for future research studies.

COVID-19 pneumonia had been a global pandemic with major mortality and morbidity globally. It is associated with venous thromboembolism, especially in the population that requires admission, oxygen support, or ventilator support. Arterial thrombosis remains rare complication for this disease, more-so with multi-organ arterial thrombosis. We report a case of spinal cord and small bowel infarction in a COVID-19 patient.

Peripheral T-Cell Lymphomas (PTCL) are an uncommon and heterogeneous group of disorders arising from the innate and adaptive immune system. This review deals with the basis and major revisions to the current PTCL classification. Each entity in the 2016 classification has been reviewed on the basis of cell origin, genetic landscape and recent therapeutic options. The objective of this study was to conduct a review of the normal immune system, signalling pathways and tumor microenvironment in order to understand the heterogeneity of certain entities as well as to uncover the potential therapeutics. A brief evaluation of a normal immune system, implication of the JAK-STAT pathway and tumor microenvironment was performed to explain the heterogeneity of PTCL. Attempts were also made to optimize current standard and personalized management approaches. Fulfilling the current unmet needs in PTCL require optimization of the intensity and number of courses of chemotherapy in first-line treatment, choosing the right strategy of intensification such as ASCT versus improved HSCT and lastly, tailoring the salvage treatment within the currently available options including HSCT, chemo-immunotherapy and targeted therapy. Further knowledge would pave a better future to better manage PTCL.

Regular exercise helps to combat multifarious diseases by improving overall health of the individual. A recent study has proven that regular exercise can reduce the serious illness associated with COVID-19. Circulating miRNAs released from the muscles during strenuous exercise has also been found to have antiinflammatory effects. So, it was hypothesized that regular exercise might be releasing therapeutic miRNAs in the blood that might be reducing the immunological chaos in COVID-19 patients. Using network and systems biology approach, mRNA targets of 3 upregulated exomiRs (hsa-miR-486-5 p, hsa-miR-215-5 p, hsa- miR-941) in the blood of regularly exercising adults were mapped in the blood of COVID-19 patients. hsa-miR-215-5 p, hsa-miR-486-5 p and hsa-miR-941 were found to target 8, 93 and 99 upregulated mRNAs respectively. Functional enrichment analysis showed that hsa-miR-486-5 p might be preventing thrombosis and aggravated inflammation in regularly exercising COVID-19 patients. Thus, hsa-miR-486-5 p can be considered to have therapeutic roles against immunological damage caused by COVID-19.