Pulmonary thrombosis seen in COVID-19 autopsies

Autopsies performed on African Americans who died from COVID-19 reveal thrombosis and microangiopathy in the small vessels and capillaries of the lungs that appear to be specific to the SARS-CoV-2 virus. 

Pathologists from New Orleans performed the first autopsy series to date in ten African Americans, with the cause of death attributed to COVID-19.

All patients had at least one comorbidity, the most common was hypertension, diabetes and obesity. In all cases, the patients presented to the hospital approximately three days to one week after developing a mild cough and fever. 

The dominant pathological process in all lungs examined was diffuse alveolar damage, accompanied by thrombosed small vessels with significant associated haemorrhage, the pathologists reported in Lancet Respiratory Medicine. 

 “Thrombi were not grossly apparent in any other organs examined, including kidney, spleen, pancreas, and liver … This thrombotic process might involve activation of megakaryocytes, possibly those native to the lung, with platelet aggregation and platelet-rich clot formation, in addition to fibrin deposition,” they wrote. 

Features of diffuse alveolar damage, including hyaline membranes, were present, even in patients who had not been ventilated. 

Cardiac findings included individual cell necrosis without lymphocytic myocarditis.

“The key implications of our study include the discovery of a mechanism for severe pathology within the African American population, likely extendable to all persons with severe disease, and possibly a target for immediate therapeutic management,” the pathologists concluded.

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