Spontaneous abdominal bleeding associated with SARS-CoV-2 infection: causality or coincidence? Abdominal bleeding and SARS-CoV-2

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Bruno Sposato
Leonardo Croci
Maurizio Di Tomassi
Camilla Puttini
Carmela Olivieri
Mario Alessandri
Maria Cristina Ronchi
Elisa Donati
Alessio Garcea
Angelica Brazzi
Maria Giovanna Migliorini
Silvia Chigiotti
Nikolaos Nikiforakis
Tiziana Carli
Elena Canneti
Francesco Strambio
Cristina Cellini
Claudia Nardangeli
Maria Pia Allegri
Francesco Bianchi
Claudio Bettini
Marco Perruzza
Nicola Lanzarone
Lucia Valentini
Paolo Orselli
Marco Solari
Salvatore Cardaci
Marco Nofri
Giorgia Angeli
Francesca Mangani
Elio Aloia
Alessandro Lanari
Marta Corridi
Genni Spargi
Antonio Perrella
Cesira Nencioni


COVID-19; SARS-CoV-2, bleeding, abdominal, pneumonia


Authors present 6 cases of abdominal bleeding associated with COVID-19, representing 1.35% of all hospitalized COVID-19 patients and hypothesize that there could be, although not very frequently, a relationship between SARS-CoV2 and bleeding. They excluded a side effect of the low molecular weight heparin therapy that all patients underwent during the course of the disease or other possible causes. Alterations of the coagulation state or a weakness of the vascular wall due toa presumed endotheliitis SARS-CoV-2 infection induced, are hypothesized by the authors. Investigation and follow-up for possible hemorrhagic problems in patients with COVID-19 is recommended. In particular, clinicians should be vigilant about retroperitoneal hemorrhage in COVID-19 patients. In addition to the fact that these patients are being treated with anticoagulants, anemia and abdominal pain are the signs that should lead us to suspect this type of haemorrhage. More studies are needed to understand if COVID-19 can be directly associated with bleeding. (www.actabiomedica.it)


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1. Wang T, Chen R, Liu C, Liang W, Guan W, Tang R. Attention should be paid to venous thromboembolism prophylaxis in the management of COVID-19. Lancet Haematol 2020; 7(5): e362-e363.
2. Wichmann D, Sperhake JP, Lütgehetmann M, Steurer S, Edler C, Heinemann A, Heinrich F, Mushumba H, Kniep I, Schröder AS, Burdelski C, de Heer G, Nierhaus A, Frings D, Pfefferle S, Becker H, Bredereke-Wiedling H, de Weerth A, Paschen HR, Sheikhzadeh-Eggers S, Stang A, Schmiedel S, Bokemeyer C, Addo MM, Aepfelbacher M, Püschel K, Kluge S. Autopsy Findings and Venous Thromboembolism in Patients With COVID-19. Ann Intern Med May 6;M20-2003. doi: 10.7326/M20-2003. Online ahead of print.
3. Lodigiani C, Iapichino G, Carenzo L, Cecconi M, Ferrazzi P, Sebastian T, Kucher N, Studt JD, Sacco C, Alexia B, Sandri MT, Barco S; Humanitas COVID-19 Task Force. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thromb Res 2020; 191: 9-14.
4. Al-Samkari H, Karp Leaf RS, Dzik WH, Carlson JC, Fogerty AE, Waheed A, Goodarzi K, Bendapudi P, Bornikova L, Gupta S, Leaf D, Kuter DJ, Rosovsky RP. COVID and Coagulation: Bleeding and Thrombotic Manifestations of SARS-CoV2 Infection. Blood 2020 Jun 3;blood.2020006520. doi: 10.1182/blood.2020006520. Online ahead of print.
5. Conti CB, Henchi S, Coppeta GP, Testa S, Grassia R. Bleeding in COVID-19 severe pneumonia: The other side of abnormal coagulation pattern? Eur J Int Med 2020; 2020; 77: 147-149.
6. Joob B, Wiwanitkit V. Hemorrhagic Problem Among the Patients With COVID-19: Clinical Summary of 41 Thai Infected Patients. Clin Appl Thromb Hemost 2020;26:1076029620918308.
7. Buja LM, Wolf D, Zhao B, Akkanti B, McDonald M, Lelenwa L Reilly N, Ottaviani G, Elghetany MT, Trujillo DO, Aisenberg GM, Madjid M, Kar B. The Emerging Spectrum of Cardiopulmonary Pathology of the Coronavirus Disease 2019 (COVID-19): Report of 3 Autopsies From Houston, Texas, and Review of Autopsy Findings From Other United States Cities. Cardiovasc Pathol 2020;48:107233.
8. Heman-Ackah SM, Su YS, Spadola M, Petrov D, Chen HI, Schuster J, Lucas T. Neurologically Devastating Intraparenchymal Hemorrhage in COVID-19 Patients on Extracorporeal Membrane Oxygenation: A Case Series. Neurosurgery 2020 May 19;nyaa198. doi: 10.1093/neuros/nyaa198. Online ahead of print..
9. Yang F, Shi S, Zhu J, Shi J, Dai K, Chen X. Online ahead of print.Analysis of 92 Deceased Patients With COVID-19. J Med Virol 2020 May 5. doi: 10.1002/jmv.25972. Online ahead of print.
10. Guotao L, Xingpeng Z, Zhihui D, Huirui W. SARS-CoV-2 infection presenting with hematochezia. Med Mal Infect 2020; 50: 293-296.
11. Shi F, Yu Q, Huang W, Tan C. 2019 Novel Coronavirus (COVID-19) Pneumonia With Hemoptysis as the Initial Symptom: CT and Clinical Features. Korean J Radiol. 2020; 21: 537-540.
12. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, Cheng Z, Yu T, Xia J, Wei Y, Wu W, Xie X, Yin W, Li H, Liu M, Xiao Y, Gao H, Guo L, Xie J, Wang G, Jiang R, Gao Z, Jin Q, Wang J, Cao B. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497–506.
13. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, Liu L, Shan H, Lei CL, Hui DSC, Du B, Li LJ, Zeng G, Yuen KY, Chen RC, Tang CL, Wang T, Chen PY, Xiang J, Li SY, Wang JL, Liang ZJ, Peng YX, Wei L, Liu Y, Hu YH, Peng P, Wang JM, Liu JY, Chen Z, Li G, Zheng ZJ, Qiu SQ, Luo J, Ye CJ, Zhu SY, Zhong NS; China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382(18): 1708-1720.
14. Yang X, Yang Q, Wang Y, Wu Y, Xu J, Yu Y, Shang Y. Thrombocytopenia and its association with mortality in patients with COVID-19. J Thromb Haemost 2020; 18(6): 1469-1472.
15. Tang N, Li D, Wang X. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 2020; 18(4): 844–847.
16. Jiang H, Liu L, Guo T. Improving the safety of CAR-T cell therapy by controlling CRS-related coagulopathy. Ann Hematol 2019; 98: 1721–1732.
17. Varga Z, Flammer AJ, Steiger P, Haberecker M, Andermatt R, Zinkernagel AS, Mehra MR, Schuepbach RA, Ruschitzka F, Moch H. Endothelial cell infection and endhothelitis in COVID-19. Lancet 2020; 395 (10234): 1417-1418.
18. Ferrario CM, Jessup J, Chappell MC, Averill DB, Brosnihan KB, Tallant EA, Diz DI, Gallagher PE. Effect of angiotensin-converting enzyme inhibition and angiotensin II receptor blockers on cardiac angiotensin-converting enzyme 2. Circulation 2005; 111(20): 2605–2610.
19. Artzner T, Clere-Jehl R, Schenck M, Greget M, Merdji H, De Marini P, Tuzin N, Helms J, Meziani F. Spontaneous ilio-psoas hematomas complicating intensive care unit hospitalizations. PLoS One 2019; 14(2): e0211680.
20. Sunga KL, Bellolio MF, Gilmore RM, Cabrera D. Spontaneous retroperitoneal hematoma: etiology, characteristics, management, and outcome. J Emerg Med 2012; 43(2): e157-61.