A COVID-19 case report with low ACT(activated clotting time) and high serum D-dimer level: Antithrombin III...

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Hematology

Background:

• Coronavirus Disease 2019 (COVID-19), caused by SARS-CoV-2, presents diagnostic challenges due to atypical symptoms beyond fever and respiratory issues.
• Atypical clinical and laboratory findings in COVID-19 complicate disease management and control efforts globally.
• Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection can trigger a cytokine storm, leading to critical illness.

Observation:

• A patient admitted to the intensive care unit with COVID-19 experienced a severe cytokine storm.
• The patient exhibited extreme D-dimer elevation (>65,000 μg/L).
• Activated clotting time (ACT) levels were unresponsive to heparin, suggesting a potential underlying coagulopathy, possibly antithrombin III (ATIII) deficiency.

Findings:

• The patient's presentation suggested a possible diagnosis of antithrombin III (ATIII) deficiency.
• Heparin resistance was observed, indicated by ACT levels not responding to anticoagulation therapy.
• The combination of COVID-19 cytokine storm and suspected ATIII deficiency presented a complex clinical scenario.

Implications:

• This case underscores the importance of recognizing and managing atypical presentations of COVID-19.
• Understanding coagulopathies like antithrombin III (ATIII) deficiency is crucial for treating severe COVID-19 cases with heparin resistance.
• Further research into the interaction between COVID-19, cytokine storms, and thrombotic complications, including specific deficiencies, is warranted for improved patient outcomes.