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Published on: Apr 30, 2020
3 minute read
By: Dr Rajan Choudhary

COVID AND CLOTTING: A BRIEF LOOK

At the Mount Sinai hospital, a case series of five patients have been put together, ready to be published in the New England Journal of Medicine. It details patients aged 33, 37, 39, 44, and 49 who all began to experience a sudden onset of symptoms including slurred speech, confusion, drooping on one side of the face, and feeling dead in one arm. At the time of writing one has sadly died, two remain hospitalized and one is in rehab. Only the youngest is able to speak. All of them were found to be COVID positive.

This drastic case series highlights a growing problem of strokes and clotting disorders in COVID patients, one noted by medics across the world. This blog looks at whether this is a common occurrence and what may be causing it.

Before reading this blog it will be helpful to read our previous blog on why and how blood clots.

THE START

In mid-February Tang et al published a paper noting that patients with abnormal clotting parameters were associated with a poorer prognosis. In their study, 11% of their patients died, but out of these patients, 71% had these abnormal parameters, compared to just 0.6% of survivors. The patients who died also demonstrated DIC (disseminated intravascular coagulation), a condition in which clotting is triggered in the patients' blood across the body, not just at the site of injury.

There is one major issue with this study. In most European hospitals patients receive anticoagulant medications on a daily basis. This is because lying in a hospital bed when ill can promote the formation of clots in your legs. Most hospitals in China do not provide this anticoagulation, but even then the incidence of clotting is remarkably high.

After this, the evidence begins piling up. 9th April, Cui et al found 25% of patients with severe COVID had clots in their legs, of which just under half died. Looking at a specific clotting parameter (D-DIMER) was remarkably accurate at predicting high-risk patients.

Italian doctors found in 16 patients in critical care with severe Acute Respiratory Distress Syndrome (a severe inflammatory condition caused by COVID) also had deranged clotting parameters.

French studies had found these sickest patients often had large clots in their lungs, blocking blood flow in the lung and causing severe issues in keeping the patient's blood well oxygenated.

Some studies showed even patients hooked up to artificial lungs (known as ECMO) were not safe from the problems caused by excessive clotting.

WHY?

So why is this occurring? As with everything in medicine, the answer is complicated and usually multifactorial. So we will simplify it.

We must look at the platelets in our blood. These fragmented cells have an important role in triggering the clotting cascade and creating a clot. During an infection white blood cells (important immune cells responsible for finding and destroying invading organisms) release many chemical signals around an infection site. This triggers platelets, the formation of small protein meshes that can literally net the viral particles in the blood.

But it looks like they have an anti-viral role as well. Researchers have found specialist receptors on platelets that recognize viruses in the blood, leading to the release of specialist anti-viral molecules that target and destroy the viruses. This is an interesting finding because it is white blood cells that are known to destroy invading organisms.

So how does it go wrong? In severe infections, there is a very large viral load, and this can cause an excessive response. Too many white blood cells release too many chemical signals, causing too many platelets to activate. The same thing can occur with the virus directly activating too many platelets at once. This results in clots forming in the blood throughout the body, including the lung and the brain. It is another instance of the body falling victim to its own protective mechanism.

A second problem is that as these platelets are activated, they and the clotting proteins in the patient’s blood are “used up”. This is dangerous, because without these platelets and clotting proteins the body is unable to stop any bleeding sites. Profuse bleeding can occur from small injuries, further complicating the treatment of the patient.

So what can be done?

Hospitals have already started looking at giving patients with severe COVID anticoagulation therapy. And it seems in patients with deranged clotting, giving anticoagulation therapy can lower mortality. The International Society on Thrombosis and Haemostasis (Clotting) has recommended that patients with severe COVID receive high dose anticoagulation medication to thin their blood, because these patients are at such high risk of clots. This regime will be used for hospital patients and those in critical care.

And what about for the everyday public? Should we be worried? So far the data suggests this is only happening in people suffering from severe symptoms of COVID. But the incident in New York certainly raises some questions, and it will be interesting to read their report in NEMJ. Should you panic and start taking anti-coagulant medication at home? Definitely not. But what you should do is be educated in the symptoms of common diseases caused by clots. Diseases such as strokes and DVTs.

STROKE

Remember, act F.A.S.T

Facial Droop on one side
Arm or hand on one side feels numb or weak with reduced power (same in one leg)
Slurred speech making it difficult to understand
Time to phone an ambulance

Other symptoms can include sudden loss in balance, sudden loss in vision in one eye, problems swallowing, and more.

DVT

Look out for a swollen, painful calf on one side that is hot to touch.

PULMONARY EMBOLISM

If you have a swollen, painful calf and are also having trouble breathing, with some sharp stabbing pain in your chest, contact the emergency services as soon as possible.

Dr Rajan Choudhary, UK, Chief Product Officer, Second Medic Inc

www.secondmedic.com

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Tuberculosis Symptoms and Treatment: Early Signs, Diagnosis, and Recovery

Tuberculosis (TB) is one of the oldest known infectious diseases and continues to be a major public health concern, especially in developing countries. India accounts for a significant proportion of global TB cases, despite advances in diagnosis and treatment. The good news is that tuberculosis is preventable, treatable and curable when detected early and managed properly.

Understanding tuberculosis symptoms and treatment is critical for reducing disease spread, preventing complications and achieving complete recovery.

What Is Tuberculosis?

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. It primarily affects the lungs (pulmonary TB) but can also involve other parts of the body such as:

lymph nodes
bones and joints
kidneys
brain

TB spreads through the air when an infected person coughs, sneezes or speaks.

Why Tuberculosis Remains a Major Health Issue

According to the World Health Organization and ICMR data:

millions of new TB cases are reported annually
delayed diagnosis increases transmission
incomplete treatment leads to drug resistance

Early detection and treatment are key to TB control.

Common Tuberculosis Symptoms

TB symptoms often develop gradually and may be mild in the early stages, leading to delayed diagnosis.

Persistent Cough

A cough lasting more than two to three weeks is a hallmark symptom of pulmonary TB.

The cough may:

be dry or productive
worsen over time
sometimes produce blood

Fever and Night Sweats

Low-grade fever, especially in the evenings, is common.

Night sweats that soak clothing or bedding are a classic TB sign.

Unexplained Weight Loss

TB increases metabolic demand and reduces appetite, leading to significant weight loss.

Fatigue and Weakness

Persistent tiredness and reduced stamina occur due to chronic infection.

Chest Pain

Chest discomfort or pain may occur during coughing or breathing.

Symptoms of Extra-Pulmonary TB

When TB affects organs outside the lungs, symptoms depend on the site involved and may include:

swollen lymph nodes
bone or joint pain
headaches or neurological symptoms
urinary issues

Why TB Symptoms Are Often Ignored

Many TB symptoms resemble common infections or general weakness.

This leads to:

delayed medical consultation
prolonged transmission
disease progression

Awareness improves early detection.

How Tuberculosis Is Diagnosed

Diagnosis involves a combination of:

sputum tests
chest X-ray
molecular tests such as CBNAAT
blood tests and imaging for extra-pulmonary TB

Early and accurate diagnosis is essential for effective treatment.

Tuberculosis Treatment Explained

TB treatment involves a combination of antibiotics taken over a fixed duration.

Standard TB Treatment

For drug-sensitive TB, treatment typically lasts:

6 months

The regimen includes multiple antibiotics taken in phases to ensure complete bacterial clearance.

Importance of Treatment Adherence

TB bacteria are slow-growing and resilient.

Stopping treatment early can result in:

incomplete cure
relapse
drug-resistant TB

Completing the full course is essential.

Drug-Resistant TB

If TB bacteria become resistant to standard drugs, treatment becomes longer and more complex.

Drug-resistant TB requires:

specialised medications
longer treatment duration
close medical supervision

Prevention of resistance depends on correct treatment from the start.

Side Effects of TB Treatment

Some individuals may experience side effects such as:

nausea
loss of appetite
mild liver enzyme changes

Most side effects are manageable with medical guidance and do not require stopping treatment.

TB and Public Health

TB is not just an individual health issue but a community concern.

Effective TB control requires:

early diagnosis
treatment adherence
contact tracing
public awareness

India’s national TB elimination programmes focus on these strategies.

Preventing Tuberculosis

Preventive measures include:

early detection and treatment of active TB
improving nutrition and immunity
adequate ventilation in living spaces
screening close contacts

BCG vaccination offers partial protection, especially in children.

Living With and Recovering From TB

With proper treatment:

symptoms gradually improve
infection becomes non-contagious
normal life can be resumed

Regular follow-up ensures complete recovery.

When to Seek Medical Help

Consult a healthcare provider if experiencing:

cough lasting more than two weeks
unexplained weight loss
persistent fever or night sweats
blood in sputum

Early action saves lives and prevents spread.

Long-Term Outlook After TB Treatment

Most individuals who complete treatment:

recover fully
regain normal lung function
return to daily activities

Long-term complications are rare with timely care.

Conclusion

Tuberculosis symptoms and treatment must be understood clearly to combat this preventable and curable disease. Persistent cough, fever, night sweats and weight loss should never be ignored. Early diagnosis, complete treatment adherence and regular follow-up are essential for curing TB and preventing transmission. With proper medical care and public awareness, tuberculosis can be effectively controlled and eliminated as a public health threat.

References

Indian Council of Medical Research (ICMR) – Tuberculosis Epidemiology and Treatment Guidelines
World Health Organization (WHO) – Global Tuberculosis Report
National Tuberculosis Elimination Programme (NTEP) – Government of India
Lancet Infectious Diseases – TB Diagnosis and Treatment Outcomes
National Family Health Survey (NFHS-5) – Infectious Disease Indicators
Statista – Global Tuberculosis Burden and Trends

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