Patients with severe
COVID-19 often experience complications including coagulopathy and fatal
thrombosis.
COVID-19 pneumonia sometimes leads to
acute respiratory distress syndrome, requiring
extracorporeal membrane oxygenation (ECMO), during which
thrombosis and
bleeding are major causes of death. Anticoagulation such as
heparin is essential for
COVID-19 patients on ECMO; however,
bleeding might be caused by not only
heparin, but also acquired von Willebrand syndrome (AVWS). To date, no study has examined ECMO-related
bleeding and AVWS in
COVID-19 patients.We report a
COVID-19 patient who experienced
bleeding from AVWS in addition to
disseminated intravascular coagulation (
DIC) during ECMO. The level of high-molecular weight VWF multimers decreased during ECMO
therapy, and these findings promptly improved after discontinuation of ECMO. Plasma levels of VWF
antigen were extremely high, probably due to endothelial cell damage caused by
COVID-19. On the other hand, plasma levels of ADAMTS13 activity were moderately reduced, to 20-30% of normal. The patient was successfully treated with cryoprecipitate in
bleeding during ECMO without a reduction in
heparin, which might have induced
thromboembolism.
Bleeding found in this patient might be caused by AVWS and
DIC.Severe
COVID-19 patients are in a thrombotic state and need to receive
anticoagulant therapy. However, once they receive ECMO
therapy,
bleeding symptoms could be observed. In such cases, physicians should think of AVWS in addition to the side effect of
heparin and
DIC.