Abstract
Coronavirus disease 2019 (COVID-19) is a global public health emergency with many clinical facets, and new knowledge about its pathogenetic mechanisms is deemed necessary; among these, there are certainly coagulation disorders. In the history of medicine, autopsies and tissue sampling have played a fundamental role in order to understand the pathogenesis of emerging diseases, including infectious ones; compared to the past, histopathology can be now expanded by innovative techniques and modern technologies. For the first time in worldwide literature, we provide a detailed postmortem and biopsy report on the marked increase, up to 1 order of magnitude, of naked megakaryocyte nuclei in the bone marrow and lungs from serious COVID-19 patients. Most likely related to high interleukin-6 serum levels stimulating megakaryocytopoiesis, this phenomenon concurs to explain well the pulmonary abnormal immunothrombosis in these critically ill patients, all without molecular or electron microscopy signs of megakaryocyte infection.
Keywords:
Coronavirus disease 2019 (COVID-19); immunothrombosis; interleukin-6 (IL-6); megakaryocytes; naked megakaryocyte nuclei; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
MeSH terms
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Adult
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Aged
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Autopsy
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Betacoronavirus / immunology
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Betacoronavirus / pathogenicity*
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Bone Marrow / immunology
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Bone Marrow / pathology*
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Bone Marrow / virology
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COVID-19
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Cell Nucleus / immunology
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Cell Nucleus / pathology
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Cell Nucleus / virology
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Coronavirus Infections / complications
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Coronavirus Infections / immunology
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Coronavirus Infections / pathology*
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Coronavirus Infections / virology
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Critical Illness
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Cytokine Release Syndrome / complications
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Cytokine Release Syndrome / immunology
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Cytokine Release Syndrome / pathology*
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Cytokine Release Syndrome / virology
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Disseminated Intravascular Coagulation / complications
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Disseminated Intravascular Coagulation / immunology
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Disseminated Intravascular Coagulation / pathology*
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Disseminated Intravascular Coagulation / virology
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Fatal Outcome
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Host-Pathogen Interactions / immunology
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Humans
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Interleukin-6 / biosynthesis
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Interleukin-6 / immunology
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Lung / immunology
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Lung / pathology*
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Lung / virology
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Male
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Megakaryocytes / immunology
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Megakaryocytes / pathology
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Megakaryocytes / virology
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Middle Aged
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Pandemics
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Pneumonia, Viral / complications
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Pneumonia, Viral / immunology
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Pneumonia, Viral / pathology*
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Pneumonia, Viral / virology
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SARS-CoV-2
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Severity of Illness Index
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Thrombopoiesis / immunology
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Thrombosis / complications
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Thrombosis / immunology
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Thrombosis / pathology*
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Thrombosis / virology
Substances
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IL6 protein, human
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Interleukin-6