Histopathological Examination with Cd61 Confirms D-Dimer as a Predictor of Diffuse Pulmonary Microthrombi Findings in Covid-19 Patients

Authors : Jilientasia Godrace Lilihataa; Bambang Pujo Semedia; Arie Utariania; Nila Kurniasarib; Etty Hary Kusumastutib; Priangga Adi Wiratamab; Isnin Anang Marhanac; Alfian Nur Rosyidc; Dwi Wahyuc; Ummi Maimunahd; Achmad Lefie; Edy Suyantof; Adhitri Anggoroc; Supriadid; Lalu Galih Pratamae; Gilang Muhammadc; Stephanie Natasha Djuandab; Komang Rusgi Yandic

Volume/Issue : Volume 7 - 2022, Issue 1 - January

Google Scholar : http://bitly.ws/gu88

Scribd : https://bit.ly/33OpL1n

DOI : https://doi.org/10.5281/zenodo.5910705

COVID-19 is a global concern that emerged and became a pandemic at March 2020. It is related to dysregulation of immune system causing excessive immune response known as cytokine storm. Other than that there is hypercoagulation that could progress to thrombosis and embolism in various vital organs. Pulmonary embolism is one of the dire consequences of hypercoagulation. CTPA and V/Q scan are the gold standards in pulmonary embolism diagnosis. However in developing countries like Indonesia these facilities are often absent. Thus a simple blood test like Ddimer could aid the detection of pulmonary thrombosis in COVID-19. Materials and methods: Subjects were 34 patients who died because of COVID-19 in COVID-19 isolation ICU at Dr. Soetomo General Hospital, Surabaya, Indonesia. Clinical information, radiologic and laboratory results were retrieved from medical record files. Histopathological examination was done by routine hematoxylin and eosin staining and CD61 immunohistochemistry staining of lung tissues. Tissues were obtained by core biopsy and examined under 100x and 400x magnification. Results: All samples examined had positive CD61 results for platelet microthrombi. Focal microthrombi were found in 61.8% of samples while the rest 38.2% had diffuse microthrombi. There was significant difference in D-dimer levels between patiens who had focal and diffuse microthrombi (p value 0.035). Analysis using ROC curve showed D-dimer level cut-off of 3055 ng/ml had 61.5% sensitivity and 71.4% specificity for the findings of diffuse pulmonary microthrombi. Conclusion: D-dimer values above 3055 ng/ml indicated the presence of diffuse microthrombi in the lungs. Ddimer can be used to aid the diagnosis of diffuse lung microthrombi in COVID-19 patients

Keywords : COVID-19, pulmonary embolism, microthrombi, D-dimer, CD61


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