Disseminated Intravascular Coagulation as the First Manifestation of Coronavirus Disease: Report of a Survived Deadly Case

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Blood Coagulation Disorders
Disseminated Intravascular Coagulation

How to Cite

EsmailzadehA., Chaichian, shahla, MehdizadehkashiA., TahermaneshK., RokhgirehS., KhodakarimN., GhafourianS., MoslemiS., & AkhlaghdoustM. (2020). Disseminated Intravascular Coagulation as the First Manifestation of Coronavirus Disease: Report of a Survived Deadly Case. Iranian Red Crescent Medical Journal, 22(8). https://doi.org/10.32592/ircmj.2020.22.8.142


Introduction: Coronavirus disease 2019 (COVID-19), newly emerging in the world as a pandemic disease, can have rare extrapulmonary manifestations. Few studies have reported coagulation disorders, induced by coronavirus; however, hemorrhage is an extremely rare and life-threatening phenomenon in COVID-19.

Case presentation: Herein, we present a 31-year-old woman referring with vaginal bleeding, melena, skin ecchymosis, mucosal bleeding, melena, hematuria, and hypovolemic shock. At our center, she was diagnosed as a case of severe internal hemorrhage due to ovulation site hemorrhage and underwent emergency surgery, complicated by prolonged international normalized ratio, which could be due to the presence of COVID-19 in the patient, detected by spiral computed tomography.

Conclusions: This case showed the importance of examining COVID-19 in any patients referring to the hospital during the pandemic as well as paying greater attention to the effect of COVID-19 on coagulation disorders in these patients.



World Health Organization. Coronavirus disease 2019 (COVID-19): situation report, 70. Geneva: World Health Organization; 2020.

Singhal T. A review of coronavirus disease-2019 (COVID-19). Indian J Pediatr. 2020;87(4):281-6. doi: 10.1007/s12098-020-03263-6. [PubMed: 32166607].

Lauer SA, Grantz KH, Bi Q, Jones FK, Zheng Q, Meredith HR, et al. The incubation period of coronavirus disease 2019 (COVID-19) from publicly reported confirmed cases: estimation and application. Ann Intern Med. 2020;172(9):577-82. doi: 10.7326/M20-0504. [PubMed: 32150748].

Poortahmasebi V, Zandi M, Soltani S, Jazayeri SM. Clinical Performance of RT-PCR and Chest CT Scan for Covid-19 Diagnosis; a Systematic Review. Adv J Emerg Med. 2020;4(2s):e57. doi: 10.22114/ajem.v4i2s.459.

Nikpouraghdam M, Farahani AJ, Alishiri G, Heydari S, Ebrahimnia M, Samadinia H, et al. Epidemiological characteristics of coronavirus disease 2019 (COVID-19) patients in Iran: a single center study. J Clin Virol. 2020;127:104378. doi: 10.1016/j.jcv.2020.104378. [PubMed: 32353762].

Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18(4):844-7. doi: 10.1111/jth.14768. [PubMed: 32073213].

Makatsariya AD, Grigoreva KN, Mingalimov MA, Bitsadze VO, Khizroeva JK, Tretyakova MV, et al. Coronavirus disease (COVID-19) and disseminated intravascular coagulation syndrome. Obstet Gynecol Reprod. 2020;14(2):123-31. doi: 10.17749/2313-7347.132.

Simmons J, Pittet JF. The coagulopathy of acute sepsis. Curr Opin Anaesthesiol. 2015;28(2):227-36. doi: 10.1097/ACO.0000000000000163. [PubMed: 25590467].

Carugno J, Sardo AD, Alonso L, Haimovich S, Campo R, De Angelis C, et al. COVID-19 pandemic. Impact on hysteroscopic procedures: a consensus statement from the global congress of hysteroscopy scientific committee. J Minim Invasive Gynecol. 2020;27(5):988-92. doi: 10.1016/j.jmig.2020.04.023. [PubMed: 32339754].

Sutton D, Fuchs K, D’alton M, Goffman D. Universal screening for SARS-CoV-2 in women admitted for delivery. N Engl J Med. 2020;382(22):2163-4. doi: 10.1056/NEJMc2009316. [PubMed: 32283004].

Watkins J. Preventing a covid-19 pandemic. BMJ. 2020;368:m810. doi: 10.1136/bmj.m810. [PubMed: 32111649].

Pryor A. SAGES and EAES recommendations regarding surgical response to covid-19 crisis. SAGES. Available at: URL: https://www sages org/recommendations-surgical-response-covid-19; 2020.

van Kasteren PB, van der Veer B, van den Brink S, Wijsman L, de Jonge J, van den Brandt A, et al. Comparison of commercial RT-PCR diagnostic kits for COVID-19. J Clin Virol. 2020;128:104412. doi: 10.1016/j.jcv.2020.104412. [PubMed: 32416600].

Fang Y, Zhang H, Xie J, Lin M, Ying L, Pang P, et al. Sensitivity of chest CT for COVID-19: comparison to RT-PCR. Radiology. 2020;296(2):E112-7. doi: 10.1148/radiol.2020200432. [PubMed: 32073353].

Mardani R, Vasmehjani AA, Zali F, Gholami A, Nasab SDM, Kaghazian H, et al. Laboratory parameters in detection of COVID-19 patients with positive RT-PCR; a diagnostic accuracy study. Arch Acad Emerg Med. 2020;8(1):e43. [PubMed: 32259132].

Giannis D, Ziogas IA, Gianni P. Coagulation disorders in coronavirus infected patients: COVID-19, SARS-CoV-1, MERS-CoV and lessons from the past. J Clin Virol. 2020;127:104362. doi: 10.1016/j.jcv.2020.104362. [PubMed: 32305883].

Sharifi-Razavi A, Karimi N, Rouhani N. COVID-19 and intracerebral haemorrhage: causative or coincidental? New Microbes And New Infect. 2020;35:100669. doi: 10.1016/j.nmni.2020.100669. [PubMed: 32322398].

Poyiadji N, Shahin G, Noujaim D, Stone M, Patel S, Griffith B. COVID-19–associated acute hemorrhagic necrotizing encephalopathy: CT and MRI features. Radiology. 2020;296(2):E119-20. doi: 10.1148/radiol.2020201187.

Carvalho A, Alqusairi R, Adams A, Paul M, Kothari N, Peters S, et al. SARS-CoV-2 gastrointestinal infection causing hemorrhagic colitis: implications for detection and transmission of COVID-19 disease. Am J Gastroenterol. 2020;115(6):942-6. doi: 10.14309/ajg.0000000000000667. [PubMed: 32496741].

Shi C, Wang C, Wang H, Yang C, Cai F, Zeng F, et al. The potential of low molecular weight heparin to mitigate cytokine storm in severe covid-19 patients: a retrospective clinical study. Clin Transl Sci. 2020;In Press. doi: 10.1111/cts.12880. [PubMed: 32881340].