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Increased blood viscosity and red blood cell aggregation in patients with COVID-19

1Laboratoire d'Hématologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon,France, lyon, Rhone-Alpes, France, 2Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team VascularBiology and Red Blood Cell, Université ClaudeBernard Lyon 1, Villeurbanne, France; Laboratoire d'Excellence du Globule Rouge(Labex GR-Ex), PRES Sorbonne, Paris, France, Lyon, Rhone-Alpes, France, 3Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team VascularBiology and Red Blood Cell, Université ClaudeBernard Lyon 1, Villeurbanne, France; Laboratoire d'Excellence du Globule Rouge(Labex GR-Ex), PRES Sorbonne, Paris, France, lyon, Rhone-Alpes, France, 4Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team VascularBiology and Red Blood Cell, Université ClaudeBernard Lyon 1, Villeurbanne, France; Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France, Lyon, Rhone-Alpes, France, 5Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Université ClaudeBernard Lyon 1, Villeurbanne, France; Laboratoire d'Excellence du Globule Rouge(Labex GR-Ex), PRES Sorbonne, Paris, France, lyon, Rhone-Alpes, France, 6Laboratoire d'Hématologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon,France, Lyon, Rhone-Alpes, France, 7Laboratoire d'Hématologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon,France, LYON, Rhone-Alpes, France, 8Service de Médecine Interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; GEMMAT, Groupe d'Etude Multidisciplinaire en Maladies Thrombotiques, Lyon, France, Lyon, Rhone-Alpes, France, 9Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team VascularBiology and Red Blood Cell, Université Claude Bernard Lyon 1, Villeurbanne, France ; Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France ; Service de Biochimie et Biologie Moléculaire, Centre de Biologie et de Pathologie Est, Hospices Civils de Lyon, Lyon, France, Lyon, Rhone-Alpes, France, 10Institut d'Hématologique et d'Oncologique Pédiatrique, Hospices Civils de Lyon, Lyon, France, Lyon, Rhone-Alpes, France, 11Service de Médecine Interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France, Lyon, Rhone-Alpes, France, 12GEMMAT, Groupe d'Etude Multidisciplinaire en Maladies Thrombotiques, Lyon, France4 Service de Médecine Intensive Réanimation, Hôpital Edouard Herriot, Lyon, France ; Unité d'Hémostase Clinique Hôpital Cardiologique Louis Pradel, Lyon, France ; UR4609 Hémostase & Thrombose, Université Claude Bernard Lyon 1, Lyon, LYON, Rhone-Alpes, France

Abstract Number: PB0044

Meeting: ISTH 2022 Congress

Theme: COVID and Coagulation » COVID and Coagulation, Clinical

Background: Endothelial injury, hypercoagulability, and decreased blood flow are suspected to play a key role in thrombosis,multiorgan failure, and death of patients with COVID-19.The link between increased blood viscosity and COVID-19-related complications and severity is not formerly established and can only be suspected.

Aims: The aim of this study was to (1) analyze blood viscosity, red blood cell (RBC) deformability, and aggregation in hospitalized patients with Coronavirus disease 19 (COVID-19); (2) test the associations between impaired blood rheology and blood coagulation; and (3) test the associations between impaired blood rheology and several indicators of clinical severity.

Methods: A total of 172 patients with COVID-19, hospitalized in COVID-unit of the Internal Medicine Department (Lyon, France) participated in this study between January and May 2021. Clinical parameters were collected for each patient. Routine hematological/biochemical parameters, blood viscosity, RBC deformability and aggregation, and RBC senescence markers were measured on the first day of hospitalization. A control group of 38 healthy individuals was constituted to compare the blood rheological and RBC profile. Rotational thromboelastography was performed in 76 patients to study clot formation dynamics.

Results: Our study demonstrated that patients with COVID-19 had increased blood viscosity despite lower hematocrit than healthy individuals, as well as increased RBC aggregation. In-vitro experiments demonstrated a strong contribution of plasma fibrinogen in this RBC hyper-aggregation. RBC aggregation correlated positively with clot firmness, negatively with clot formation time, and positively with the length of hospitalization. Patients with oxygen supplementation had higher RBC aggregation and blood viscosity than those without, and patients with pulmonary lesions had higher RBC aggregation and enhanced coagulation than those without.

Conclusion(s): This study is the first to demonstrate blood hyper-viscosity and RBC hyper-aggregation in a large cohort of patients with COVID-19 and describe associations with enhanced coagulation and clinical outcomes.

To cite this abstract in AMA style:

Nougier C, Nader E, Boisson C, Poutrel S, CATELLA J, Martin F, Charvet J, Girard S, Havard-Guibert S, Martin M, Rezigue H, Desmurs-Clavel H, Renoux C, Joly P, Guillot N, Bertrand Y, Hot A, Dargaud Y, Connes P. Increased blood viscosity and red blood cell aggregation in patients with COVID-19 [abstract]. https://abstracts.isth.org/abstract/increased-blood-viscosity-and-red-blood-cell-aggregation-in-patients-with-covid-19/. Accessed September 24, 2023.

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