Complex immune reaction Why the blood clumps with Covid-19


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Foto: imago images/Science Photo Library

One of the puzzling complications of Covid-19 disease is the real clumping of the patient’s blood. Why this happens has so far remained unclear. Now US scientists are finding an approach and already have an idea of ​​which drugs could work. In the case of infections with Sars-CoV-2, in addition to diseases of the lungs and other organs, blood clotting disorders are also repeatedly observed in the patient. In some Covid-19 sufferers, the blood seems to really clump together. This leads to strokes or pulmonary embolisms. When examining deceased patients, doctors often found thromboses and blood clots in arteries, veins and also capillaries. „In patients with Covid-19 we see a relentless, self-reinforcing vicious circle of inflammation and clumping of the blood throughout the body,“ explains Yogendra Kanthi of the University of Michigan.

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He is the co-author of a US study that investigated the cause of this increased coagulation and was published in „Science“ magazine. Because the cause has so far remained unclear. „Most patients have normal levels of blood clotting factors, fibrinogen and platelets, suggesting that Covid-19 causes a unique prothrombotic condition,“ explain Kanthi and colleagues. Theoretically, this could be a direct effect of the virus, but inflammation of the blood vessels or disturbances in the biochemical regulation of blood coagulation appeared as possible causes, as well as the body’s immune reaction to the corona infection. For their study, the scientists analyzed the blood of 172 hospital-treated Covid 19 patients with severe disease. They specifically looked for eight antibodies that are typical of the so-called antiphospholipid syndrome. This autoimmune disease can also lead to fatal clumping of the blood.

More antibodies, more serious illness

„A good half of the Covid-19 patients were positive for at least one of these auto-antibodies,“ reports Jason Knight, one of the study authors. A quarter of the patients had two or more of these antibodies. There were clear connections with the course of the Covid 19 disease: the more auto-antibodies the patient had in the blood, the more difficult the disease process. „This suggests that these auto-antibodies could be the culprits in this vicious circle of blood clotting and inflammation that makes many Covid patients so sick,“ says Kanthi. Apparently, the infection with Sars-CoV-2 directly or indirectly promotes the production of these misdirected antibodies and thus derails blood clotting. The affected patients also often had white blood cells that were overactivated by the antibodies. These immune cells then produce extracellular fibers that normally help fight bacteria and therefore form a kind of network. In this case, however, they further increase blood clotting. When the scientists checked their results with mice, they used antibodies from seriously ill Covid-19 patients to produce „astonishing levels of thrombosis“ in them too. The study results could also lead to better treatment of this derailed blood clotting. In addition to the anticoagulant heparin, which has already been administered in many Covid 19 cases, the antiphospholipid syndrome is also treated with the active ingredient dipyridamole. „It’s an old drug that is safe, cheap and widely available,“ says Kanthi. Initial tests now suggest that this agent could also help with Covid-19. Therefore, the research team has already started a clinical study with the drug. They also recommend checking the effectiveness of a blood wash, which specifically filters out certain components of the blood.

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