From pregnancy to SARS Cov II- pandemia. “Like a bridge over troubled waters” COVID 19: a new virus- induced thrombotic microangiopathy model? LDH/AST ratio diagnostic role

Abstract

Several scientific studies have shown that SARS-CoV II infection, responsible for the COVID 19 pandemic, can lead to a state of thrombotic microangiopathy (TM), both thrombotic thrombocytopenic purpura-like (TTP-like) and atypical hemolytic-uremic syndrome-like (aHUS-like), similarly to what occurs in the major thrombotic complications of pregnancy. The differential diagnosis between these disorders is very complex, due to overlapping clinical features, and also because they affect various disciplines. In the context of thrombotic microangiopathies, the test for the evaluation of ADAMTS-13 plays a key role, but in the pending or absence of the ADAMTS-13 test we can use PLASMIC score and /or LDH/AST ratio and these can help in the early stages of the disease. TTP and aHUS have different treatments: plasmapheresis in the TTP and Eculizumab in the aHUS. Therefore, we propose to the scientific community the LDH / AST score as a diagnostic aid, to help the differential diagnosis between the SARS-CoV II associated-TM and direct towards a more specific and effective therapy, in Covid-19 critical Patients.