Journal Article

COVID-19 induces a hyperactive phenotype in circulating platelets

Cullen, Steven, Kelliher, Sarah, Maguire, Patricia B., McCullagh, Brian, Mallon, Patrick, Szklanna, Paulina B., Ní Áinle, Fionnuala, O’Reilly, Katherine, Cullivan, Sarah, Weiss, Luisa, Murphy, Claire, Gaine, Sean, Altaie, Haidar, Curran, John, Comer, Shane P., Moran, Niamh, Cotter, Aoife G., Marsh, Brian, Kevane, Barry, Smolenski, Albert

2021

Overview

Coronavirus Disease 2019 (COVID-19), caused by the novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), has affected over 30 million globally to date. Although high rates of venous thromboembolism and evidence of COVID-19-induced endothelial dysfunction have been reported, the precise aetiology of the increased thrombotic risk associated with COVID-19 infection remains to be fully elucidated. Therefore, we assessed clinical platelet parameters and circulating platelet activity in patients with severe and nonsevere COVID-19. An assessment of clinical blood parameters in patients with severe COVID-19 disease (requiring intensive care), patients with nonsevere disease (not requiring intensive care), general medical in-patients without COVID-19, and healthy donors was undertaken. Platelet function and activity were also assessed by secretion and specific marker analysis. We demonstrated that routine clinical blood parameters including increased mean platelet volume (MPV) and decreased platelet:neutrophil ratio are associated with disease severity in COVID-19 upon hospitalisation and intensive care unit (ICU) admission. Strikingly, agonist-induced ADP release was 30- to 90-fold higher in COVID-19 patients compared with hospitalised controls and circulating levels of platelet factor 4 (PF4), soluble P-selectin (sP-selectin), and thrombopoietin (TPO) were also significantly elevated in COVID-19. This study shows that distinct differences exist in routine full blood count and other clinical laboratory parameters between patients with severe and nonsevere COVID-19. Moreover, we have determined all COVID-19 patients possess hyperactive circulating platelets. These data suggest abnormal platelet reactivity may contribute to hypercoagulability in COVID-19 and confirms the role that platelets/clotting has in determining the severity of the disease and the complexity of the recovery path.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Activation / Adenosine Triphosphate - metabolism / Aged / Autopsy / Biology and Life Sciences / Blood Coagulation / Blood platelets / Blood Platelets - cytology / Blood Platelets - virology / Body mass index / Cardiovascular diseases / Circulating anticoagulants / Contraindications / Coronaviruses / COVID-19 / COVID-19 - blood / Critical care / Dengue / Dengue fever / Diabetes mellitus / Enzyme-Linked Immunosorbent Assay / Female / Gene expression / Health aspects / Health risks / Hemostasis / Hospitals / Humans / Hyperactivity / Hypertension / Immune response / Infections / Inflammation / Intensive care / Intensive Care Units / Male / Mean Platelet Volume / Medical laboratories / Medicine and Health Sciences / Middle Aged / Molecular weight / Mortality / Neutrophils / Organs / P-Selectin - blood / Patients / Phenotype / Phenotypes / Physiological aspects / Plasma / Platelet Factor 4 - blood / Platelet Function Tests / Platelet-rich plasma therapy / Platelets / Risk analysis / Risk factors / Severe acute respiratory syndrome coronavirus 2 / Testing / Thrombocytopenia / Thromboembolism / Thrombopoietin - blood / Thrombosis / Vector-borne diseases / Viral diseases / Viral infections