• Published on: Apr 28, 2020
  • 4 minute read
  • By: Dr Rajan Choudhary

Strokes In The Young And How COVID Causing Clotting Disorders?

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Strokes in the young and healthy: how is COVID causing clotting disorders?

In the news, there has been a rush in stories linking Strokes in young and healthy patients, patients who also have COIVD-19. This is certainly worrying news, and at first glance, it is difficult to explain. How does a respiratory virus, one that is very similar to the coronavirus responsible for the common cold, cause such serious issues in a completely unrelated organ system? In this two-part series we will first go over the basics of clotting and its function, how clotting can cause problems, and finally how COVID can lead to clotting disorders.

STROKES

Before we progress, if you or a family member are having any of the following symptoms, contact your local emergency services immediately. Strokes can be devastating, and treatment needs to be given as soon as possible to save as much of the brain as we can. Early recognition can be the difference between manageable long term effects and crippling disability.

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.

PLUGGING A HOLE

We have an intricate network of vessels to transport oxygen, nutrients, and signals to cells and organs across our bodies. Damage to these blood vessels causes blood loss, reduction in oxygen and nutrient delivery to these cells, and organ damage if the issue isn’t rectified. Failure in multiple organ systems across the body will eventually lead to death. Our blood has cells and proteins that work together to form a clot at the site of injury. This acts as a plug to physically stop the leak, but also encourages repair of the blood vessel and surrounding tissue.

A clot can be triggered in three different ways: blood stasis (pooling up in one area), exposure of blood vessel lining, and pro-coagulant factors released into the blood. When triggered a coagulation cascade occurs to form the building blocks of a clot – it works so well that even a small trigger can create a response big enough to repair the damage. These form a mesh trapping platelets and other blood cells into a plug. Immune cells also arrive to destroy any organisms that might enter from the trauma site that caused the injury, and these immune cells also instruct nearby cells to begin the repair process.

As with everything in our body the whole process is very tightly regulated. The cascade has triggers and accelerators, but it also has brakes. These brakes stop a clot from growing too big, or from clots forming spontaneously when they are not needed. They also help dissolve a clot once the vessel is repaired and it isn’t needed.

WHEN IT GOES WRONG

Heart attacks and strokes. These devastating cardiovascular diseases are well recognized by the public as a leading cause of disability and death. Both can be caused by abnormal clotting. How does our finely tuned clotting cascade turn abnormal? Let's go back to the three triggers of blood clotting.

Vessel damage: Eating a high fat and cholesterol diet can cause fatty plaques to build up in our arteries. This is known as atherosclerosis, and it is extremely common. The plaques can narrow your arteries and reduce blood flow. If this happens in your coronary arteries supplying your heart muscles, your heart might not receive enough oxygen when you exercise or exert yourself. This can cause chest pain, known as angina.

If the plaques burst open it can expose the vessel lining, causing a large clot to form. This clot can become dislodged and be carried away by the blood. It will eventually get lodged in a narrow artery, blocking it and stopping blood from entering. The tissue and cells supplied by that artery will not receive oxygen and eventually die. If this happens in the coronary arteries it can cause a heart attack. In the arteries supplying the brain, it can cause a stroke, leading to neurological deficits.

THIS IS THE MOST IMPORTANT LEARNING POINT, and this is why a healthy diet low in fat and sugars is so important. 

Stasis: Our heart pumps blood at high pressures through the arteries. But in the veins, there is very little pressure to drive the blood back to the heart. In our arms and head, gravity helps blood flow down to the heart. But from our legs? When we walk the muscles in our legs squeeze the veins and move the blood. Valves make sure this flow is only one way, back to the heart.

If we sit or lie down in one place and don’t move, the blood isn’t pumped back and pools up in our legs, causing a clot to form. This usually happens in our calves (known as a DEEP VEIN THROMBOSIS, or DVT). The calf becomes swollen, painful, red, and hot. If this clot is dislodged, it can end up in our lungs causing a PULMONARY EMBOLISM. A large PE can block blood from entering the lungs and can be fatal. This is why you should take regular walks on long haul flights, to prevent blood from pooling.

Pro-coagulant: Sometimes the factors in our blood responsible for triggering a clot can be triggered accidentally. Cigarette smoke contains many toxins and harmful chemicals that, when inhaled, end up in your blood. These chemicals can cause damage to vessel linings, and also cause the clotting cascade to be triggered more easily. Some medications, such as the Combined Oral Contraceptive Pill, also have a similar effect, though the risk of getting a clot is still very low.

The immune system can also trigger a clot. The protein mesh formed in the blood can also capture bacteria and viruses around an infection site, making it easier for immune cells to find and destroy these invading organisms. In cancer patients, this process is sometimes triggered by unregulated cancer cells.

WHAT HAVE WE LEARNT?

Our clotting system stops us from bleeding to death from a small wound. People who have bleeding disorders are clear examples and need to be extremely careful if they injure themselves. But unregulated, our body can end up harming itself. If there is one thing you should take away from this, it is that a high sugar/high-fat diet with little exercise can directly increase your risk of having a heart attack or stroke. This is why doctors emphasize so much the importance of a good diet and exercise.

In our next blog, we will look at how this clotting problem is implicated in COVID patients.

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

www.secondmedic.com

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Vitamin D

Vitamin D Deficiency Symptoms: Signs Your Body May Be Lacking Vitamin D

Vitamin D is an essential nutrient that plays a vital role in maintaining strong bones, supporting the immune system and regulating several important functions in the body. Despite its importance, vitamin D deficiency is one of the most common nutritional deficiencies worldwide.

In India, vitamin D deficiency has become increasingly prevalent due to lifestyle factors such as limited sunlight exposure, indoor working environments and dietary habits. According to the Indian Council of Medical Research (ICMR), a significant percentage of the population may have insufficient vitamin D levels.

Recognizing the symptoms of vitamin D deficiency early is important because prolonged deficiency can lead to serious health complications affecting bones, muscles and overall wellbeing.

What Is Vitamin D and Why Is It Important?

Vitamin D is often called the “sunshine vitamin” because the body produces it when the skin is exposed to sunlight. It plays a key role in calcium absorption, which is essential for maintaining healthy bones and teeth.

In addition to bone health, vitamin D supports several important functions including:

immune system regulation
muscle function
inflammation control
hormonal balance

Low levels of vitamin D can disrupt these functions and contribute to various health problems.

Common Symptoms of Vitamin D Deficiency

Vitamin D deficiency can manifest through several symptoms, many of which are often overlooked or mistaken for other health issues.

Persistent Fatigue

Constant tiredness or low energy levels may be one of the earliest signs of vitamin D deficiency. Even after adequate rest, individuals with low vitamin D levels may continue to feel exhausted.

Vitamin D plays a role in cellular energy production, and insufficient levels may contribute to chronic fatigue.

Bone and Back Pain

One of the most well-known effects of vitamin D deficiency is bone discomfort. Vitamin D helps the body absorb calcium, which is essential for maintaining bone strength.

Low vitamin D levels may cause:

bone pain
lower back pain
increased risk of fractures

Persistent bone discomfort should be evaluated by a healthcare professional.

Muscle Weakness

Vitamin D is important for muscle health and function. Deficiency can lead to muscle weakness, cramps or general muscle fatigue.

Older adults with vitamin D deficiency may also experience reduced mobility and increased risk of falls.

Frequent Illness or Infections

Vitamin D plays a key role in supporting the immune system. Individuals with low vitamin D levels may experience frequent colds, infections or slower recovery from illness.

Research suggests that adequate vitamin D levels help strengthen immune defenses against respiratory infections.

Mood Changes and Depression

Vitamin D may influence brain function and mood regulation. Some studies have found a connection between low vitamin D levels and mood disorders such as depression or anxiety.

People experiencing persistent mood changes should consider evaluating vitamin levels as part of a broader health assessment.

Hair Loss

Severe vitamin D deficiency may contribute to hair thinning or hair loss. While hair loss can have multiple causes, nutritional deficiencies including vitamin D deficiency may play a role.

Slow Wound Healing

Vitamin D contributes to the body’s inflammatory response and tissue repair processes. Individuals with deficiency may notice slower wound healing or delayed recovery from injuries.

Who Is at Risk of Vitamin D Deficiency?

Several factors can increase the risk of vitamin D deficiency.

Limited Sun Exposure

People who spend most of their time indoors or use strong sun protection regularly may not receive enough sunlight to produce sufficient vitamin D.

Urban lifestyles and indoor work environments contribute to this problem.

Older Adults

As people age, the skin becomes less efficient at producing vitamin D from sunlight. Older adults may therefore require additional dietary intake or supplements.

Individuals with Darker Skin

Melanin reduces the skin’s ability to produce vitamin D from sunlight. Individuals with darker skin tones may require longer sun exposure to produce adequate levels.

Poor Dietary Intake

Few foods naturally contain vitamin D. Diets lacking fortified foods, dairy products or fatty fish may contribute to deficiency.

Medical Conditions

Certain medical conditions such as kidney disease, liver disease or digestive disorders can affect vitamin D absorption and metabolism.

How Is Vitamin D Deficiency Diagnosed?

Vitamin D deficiency is diagnosed through a simple blood test that measures the level of 25-hydroxyvitamin D in the bloodstream.

Doctors may recommend testing for individuals who experience symptoms of deficiency or belong to high-risk groups.

Early diagnosis allows healthcare providers to recommend appropriate treatment and lifestyle adjustments.

How to Improve Vitamin D Levels

Sunlight Exposure

Regular sunlight exposure is one of the most effective ways to increase vitamin D levels. Experts generally recommend 10 to 30 minutes of sunlight exposure several times per week, depending on skin type and location.

Dietary Sources of Vitamin D

Although limited, certain foods contain vitamin D, including:

fatty fish such as salmon and mackerel
egg yolks
fortified milk and cereals
mushrooms

Including these foods in the diet can help maintain healthy vitamin D levels.

Vitamin D Supplements

In cases of significant deficiency, doctors may recommend vitamin D supplements. The dosage depends on the individual’s vitamin levels, age and health status.

It is important to take supplements under medical supervision to avoid excessive intake.

Preventing Vitamin D Deficiency

Maintaining adequate vitamin D levels requires a balanced combination of sunlight exposure, proper nutrition and regular health monitoring.

Routine health checkups and vitamin testing can help identify deficiencies early and prevent complications.

Adopting a healthy lifestyle with balanced nutrition and outdoor activity can significantly improve vitamin D status and overall health.

Conclusion

Vitamin D deficiency is a common but often overlooked health concern. Symptoms such as fatigue, bone pain, muscle weakness and frequent infections may indicate low vitamin D levels.

Early detection and proper management are essential to prevent long-term health complications. By ensuring adequate sunlight exposure, maintaining a balanced diet and undergoing regular health checkups, individuals can support healthy vitamin D levels and improve overall wellbeing.

Recognizing the warning signs of vitamin D deficiency and seeking timely medical advice can help protect long-term health and maintain optimal body function.

References

  • Indian Council of Medical Research (ICMR) – Nutritional Deficiency Reports

  • World Health Organization (WHO) – Micronutrient Deficiency Guidelines

  • National Institute of Nutrition (NIN) India – Vitamin D Research Reports

  • Lancet Public Health – Nutritional Health Studies

  • National Institutes of Health (NIH) – Vitamin D Fact Sheets for Health Professionals

See all

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