MORE ON DEEP HEMATOMAS IN PATIENTS WITH COVID-19: CASE SERIES.

Background: Despite the fact that the COVID-19 epidemic has already ended, there is no clear answer to the question - what is the nature of the imbalance in the hemocoagulation system, and which phenomena prevail - thrombosis or hemorrhage? More and more new works appear describing the occurrence of deep, extensive hematomas in patients with COVID-19. However, this experience requires further discussion and understanding.

Case description: From October 2020 to January 2021, 7 (2,1% among all hospitalized with COVID-19 in this period) patients with developed hematomas were observed at the COVID-19 hospital. All of them, taking into account their severe condition (according to the SOFA scale) and the high risk of thromboembolic complications (according to the Caprini scale), received a therapeutic dose of calcium nadroparin. Superficial hematomas were observed in 2 patients, and deep hematomas - in 5 patients. Their volume was up to 340 ml. Instrumental diagnostics included ultrasound and computed tomography. The most difficult were hematomas in the area of musculus iliopsoas. The median time of the onset of hematomas from the start of treatment was 7 days (interquartile range [IQR], 4-9 days). The indication for puncture was a hematoma volume of more than 100 ml, as well as a suspicion of suppuration. Analysis of coagulograms revealed signs of hypercoagulation and imbalance in the blood coagulation system. In 3 patients, the D-dimer level exceeded 4000 ng/ml. They were fatal, and autopsy revealed multiple thrombosis of the small branches of the pulmonary artery. Deep vein thrombosis of the lower extremities was not detected. The mortality rate among patients with developed hematomas was 42.9%, and the average mortality rate for this hospital in the indicated period of time was 7.1%.

Conclusions: An imbalance in which, along with thrombotic complications, hemorrhagic manifestations are observed, is one of the features of COVID-19. The deep hematomas developing at the same time are poorly understood and sharply complicate the course of the infection.