Haematological manifestations, mechanisms of thrombosis and anti-coagulation in COVID-19 disease: A review

Coronavirus-19 disease (COVID-19), a zoonosis, was first reported in the city of Wuhan, province of Hubei, China in December 2019. The disease is caused by the Severe Acute Respiratory Syndrome-CoronaVirus-2 (SARS-CoV-2). As of 12(th) of May 2020, 4,256,022 confirmed cases affecting 212 countries with 287,332 deaths have been reported. The common symptoms reported in patients with COVID-19 are fever, dry cough, dyspnoea and gastrointestinal symptoms such as vomiting and diarrhoea. Non-survivors often succumb due to widespread pulmonary intravascular coagulopathy, arterial and venous thromboembolism, disseminated intravascular coagulopathy (DIC), secondary hemophagocytic lymphohistiocytosis (sHLH), and multiorgan dysfunctional syndrome (MODS). All hospitalised patients should be monitored closely for thrombotic events. Patients who develop bleeding episodes should be managed according to standard DIC guidelines. The main objectives of this review are 1) to provide a succinct background of this novel disease 2) discuss the haematological presentations and mechanisms of thrombosis 3) emphasize the role of anti-coagulation prophylaxis 4) explore the management of coagulopathy 5) provide insight on management of patients with COVID-19 disease and pre-existing bleeding disorders.