Diagnosis and treatment of spontaneous hemorrhages in soft tissues in patients with COVID-19

The development of extrapulmonary complications of COVID-19, specifically spontaneous hemorrhages in soft tissues, is associated with higher expression of angiotensin-converting enzyme type 2 in the gastrointestinal tract compared to the respiratory tract. Currently, a triggering mechanism in the development of hemorrhages cannot be ruled out, which may be induced by heparin-induced coagulopathy and critical conditions accompanied by the production of pro-inflammatory factors in the bloodstream. Since the onset of COVID-19, there has been an increase in the frequency of spontaneous hemorrhages in soft tissues, and this complication is linked to the possible direct impact of the SARS-CoV-2 virus on compromised endothelium. Objective. Based on a comprehensive clinical, laboratory, and instrumental examination, including pathomorphological and immunohistological analysis, to determine optimal approaches for the diagnosis and treatment of patients with spontaneous hematomas in soft tissues due to COVID-19. Material and methods. The study involved 39 patients with spontaneous hemorrhages in soft tissues of various anatomical locations. Results. The development of spontaneous hematomas in soft tissues in patients with COVID-19 is a serious complication, often with an unfavorable prognosis, requiring a personalized treatment strategy. The therapeutic approach was based on choosing a strategy ranging from non-invasive to minimally invasive techniques. Immunohistological analysis was conducted using monoclonal antibodies against CD31, CD34, CD68 receptors, and factor vWF, revealing alterations in the endothelial monolayer that contribute to the occurrence of hemorrhagic events. Conclusion. It can be suggested that the increased frequency of spontaneous hematomas in soft tissues among COVID-19 patients may be associated with the direct cytopathic effect of the SARS-CoV-2 virus on endothelial cells (destruction of the vascular wall due to degradation of the endothelial layer). Minimally invasive procedures are the most preferred methods for stopping bleeding from feeding vessels in patients with COVID-19.

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