PMID- 32583809
OWN - NLM
STAT- MEDLINE
DCOM- 20201008
LR  - 20201218
IS  - 0974-7559 (Electronic)
IS  - 0019-6061 (Print)
IS  - 0019-6061 (Linking)
VI  - 57
IP  - 9
DP  - 2020 Sep 15
TI  - COVID-19 Associated Hemophagocytic Lymphohistiocytosis and Coagulopathy: 
      Targeting the Duumvirate.
PG  - 827-833
LID - S097475591600204 [pii]
AB  - CONTEXT: Preliminary data on coexistence of secondary hemophagocytic 
      lymphohistiocytosis syndrome (HLH) and disseminated intravascular coagulation 
      (DIC) in critically ill children with novel coronavirus disease (COVID-19) are 
      emerging. Herein, we summarize the available literature and fill-in the gaps in 
      this regard. EVIDENCE ACQUISITION: We have performed a literature search for 
      articles in PubMed, EMBASE and Google Scholar databases till May 12, 2020, with 
      following keywords: "COVID-19", "SARS-CoV-2", "HLH", "HScore", "coagulopathy", 
      "D-dimer", "cytokine storm", "children" and "pediatrics" with interposition of 
      Boolean operator "AND". RESULTS: Children presenting with moderate-severe 
      COVID-19 and Kawasaki disease shock-like syndrome exhibit peripheral blood 
      picture analogous to HLH. HScore, a validated tool to diagnose HLH, has been 
      suggested to screen severe COVID-19 patients for cytokine storm. However, HScore 
      faces certain limitations in this scenario. It may be more pragmatic to use 'high 
      D-dimer' (> 3 microg/mL) instead of 'low fibrinogen' to facilitate early detection of 
      cytokine storm. COVID-19 associated coagulopathy resembles hypercoagulable form 
      of DIC with bleeding being rarely reported. Although the International Society on 
      Thrombosis and Haemostasis (ISTH) interim guidance recommends low molecular 
      weight heparin in all hospitalized patients, data is lacking in population below 
      14 years of age. However, in the presence of life-threatening thromboembolic 
      event or symptomatic acro-ischemia, unfractionated heparin (UFH) should be used 
      with caution. CONCLUSIONS: HScore can be used as a complement to clinical 
      decision for initiating immunosuppression. Children with moderate-to-severe 
      COVID-19, especially those with documented thrombocytopenia or chilblains, should 
      be regularly monitored for coagulopathy.
FAU - Bhattacharjee, Sukrita
AU  - Bhattacharjee S
AD  - Institute of Hematology and Transfusion Medicine, Medical College and Hospital, 
      Kolkata, West Bengal, India. Correspondence to: Dr Sukrita Bhattacharjee, 
      Department of Hematology, Institute of Hematology and Transfusion Medicine, 
      Medical College and Hospital, Kolkata, India. skrtbhttchry@gmail.com.
FAU - Banerjee, Mainak
AU  - Banerjee M
AD  - Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, 
      India.
FAU - Pal, Rimesh
AU  - Pal R
AD  - Post Graduate Institute of Medical Education and Research, Chandigarh, India.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20200624
PL  - India
TA  - Indian Pediatr
JT  - Indian pediatrics
JID - 2985062R
SB  - IM
MH  - *Betacoronavirus
MH  - Blood Coagulation Disorders/*diagnosis/therapy/*virology
MH  - COVID-19
MH  - Coronavirus Infections/*complications/diagnosis/therapy
MH  - Humans
MH  - Lymphohistiocytosis, Hemophagocytic/*diagnosis/therapy/*virology
MH  - Pandemics
MH  - Pneumonia, Viral/*complications/diagnosis/therapy
MH  - SARS-CoV-2
PMC - PMC7498551
EDAT- 2020/06/26 06:00
MHDA- 2020/10/09 06:00
PMCR- 2020/09/18
CRDT- 2020/06/26 06:00
PHST- 2020/06/26 06:00 [pubmed]
PHST- 2020/10/09 06:00 [medline]
PHST- 2020/06/26 06:00 [entrez]
PHST- 2020/09/18 00:00 [pmc-release]
AID - S097475591600204 [pii]
AID - 1962 [pii]
AID - 10.1007/s13312-020-1962-z [doi]
PST - ppublish
SO  - Indian Pediatr. 2020 Sep 15;57(9):827-833. doi: 10.1007/s13312-020-1962-z. Epub 
      2020 Jun 24.