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HAEMATOLOGY


Research


The hypotheses involving PV are based on anecdotal evidence and need to be proven through clinical laboratory trials. Bernie Benson, founder of Benson Viscometers, says: “We are seeking to work with clinical and academic groups, potentially to form partnerships to undertake the required analysis. If anyone is planning to undertake a study or trial, we would welcome discussions to progress this. The plasma viscosity test could be specifically used as part of local COVID-19 screening blood work and also to monitor the intensity and progress of the virus episode in a patient, especially given most hospitalised COVID-19 patients are already having daily haematology and chemistry profiles carried out.”


Safe, inexpensive and precise For safety reasons, laboratories are applying the principles of ‘closed vial sampling’ more rigidly now and, as a result, any test on a COVID-19 patient that is underfilled or requires the sample top to be removed is generally refused unless in exceptional circumstances.


The PV analysis is carried out without removing the sample tube cap so is ideally suited to the current circumstances and will provide rapid and straightforward numerical results. There is one normal range for all ages and both sexes (1.5–1.72 milliPascal- second), which is already well established and documented for over 50 years, meaning results interpretation is straightforward and there is no requirement to establish a normal range.


Plasma viscosity is a safe and inexpensive test that is capable of a precise result with a high level of confidence within minutes of a blood sample arriving in the hospital laboratory. All the NHS clinical viscometers in use are manufactured and supplied by a British company. They are already operational, programmed and linked via the NHS laboratory information management system (LIMS), enabling hospitals to manage samples effectively and automatically communicate results and associated data. Therefore, obtaining results for a multi-centre trial is easy.


Conclusions


The role of plasma viscosity in COVID-19 is an avenue which cannot be ignored.


In the battle against the disease, we need the shared knowledge and contributions of research, statistical analysis and ‘lessons learned’ from a wide range of disciplines. Haematology is emerging as a discipline with a crucial role to play. The PV test will play a significant part in that, as both an individual test and as part of a routine blood work-up panel. To facilitate this, there now needs to be as many PV tests performed as possible to provide large amounts of meaningful data that can be evaluated and statistically analysed to assist with COVID-19 and also with any future pandemics. For any laboratories with a reduced routine workload volume, this is an opportune time to utilise available capacity and existing equipment to support finding the answers to COVID-19.


References 1. Viner RM, Whittaker E. Kawasaki-like disease: emerging complication during the COVID-19 pandemic. Lancet 2020 May 13. doi: 10.1016/ S0140-6736(20)31129-6. Online ahead of print.


Benson Viscometers is exploring the possibility with partner laboratories of early identification of COVID-19 patients who go on to develop severe symptoms


OCTOBER 2020


2. Levi M, Thachil A, Toshiaki I, Levy JH. Coagulation abnormalities and thrombosis in patients with COVID-19. Lancet Haematol 2020 May 11: S2352-3026(20)30145-9. doi: 10.1016/S2352- 3026(20)30145-9. Online ahead of print.


Suggested further reading l Cao M, Zhang D, Wang Y et al. Clinical features of patients infected with the 2019 novel coronavirus (COVID-19) in Shanghai, China. medRxiv preprint doi: 10.1101/2020.03.04.20030395.


l Fan BE, Chong VCL, Chan SSW et al. Hematologic parameters in patients with COVID-19 infection. Am J Hematol 2020; 95 (6): E131–E134. doi: 10.1002/ ajh.25774. Epub 2020 Mar 19.


CSJ


l Klok FA, Kruip MJHA, van der Meer NJM et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res 2020 Apr 10: S0049-3848(20)30120-1. doi: 10.1016/j. thromres.2020.04.013. Online ahead of print.


l Lippi G, Plebani M. Laboratory abnormalities in patients with COVID-2019 infection. Clin Chem Lab Med 2020 Mar 3;/j/cclm.ahead-of-print/cclm-2020- 0198/cclm-2020-0198.xml. doi: 10.1515/cclm- 2020-0198. Online ahead of print.


l Maier CL, Truong D, Auld SC, Polly DM, Tanksley CL, Duncan A. COVID-19-associated hyperviscosity: a link between inflammation and thrombophilia? Lancet 2020 May 25; S0140-6736(20)31209-5. doi: 10.1016/ S0140-6736(20)31209-5. Online ahead of print.


l Tang N, Bai H, Chen X, Gong J, Li D, Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost 2020; 18 (5): 1094–9. doi: 10.1111/jth.14817.


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