COVID-19: Autopsies Reveal Blood Clots in Kidneys, Lung Injuries

A new post-mortem study from British researchers reveals that patients who died from COVID-19 experienced lung injuries and signs of thrombosis—clotting of the blood—in major organs.

Researchers from the Imperial College London and Imperial College Healthcare NHS Trust conducted autopsies on patients who were confirmed to have contracted the coronavirus disease (COVID-19). Their study is published in the journal The Lancet Microbe on Thursday, August 20.

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Autopsies on COVID Patient Deaths

The research team found that all patients observed in the post-mortem study had lung injuries and scarring in the respiratory organs due to the virus. Kidney injuries were also common. Additionally, nine of the patients were found to have thrombosis, or blood clotting, in at least one of their major organs—kidney, lungs, or heart. However, a press release also noted that the research team was unable to investigate blood clotting in one of the patients.

In their research methodology, the team noted that patients in the study were older than 18 years of age and had a premortem diagnosis of SARS-CoV-2 infection. In the study, the patients were from 22 to 97 years old. It also noted that COVID-19 had been the direct cause of death for all patients studied.

For the patients, seven were men, while three were women. Additionally, five of the patients studied were of Asian ethnicities, which the researchers noted might later be relevant for succeeding studies where ethnicities were a factor. They cited a previous study inquiring whether ethnicity is related to the incidence or outcomes of the coronavirus disease.

The researchers also secured full consent from the relatives and friends of the deceased, compliant to national protocols, before conducting autopsy and tissue sampling for research purposes. From March to June 2020, biopsies were done at hospitals by Imperial College Healthcare NHS Trust.

"COVID-19 is a new disease, and we have only had limited opportunities to comprehensively analyze tissues from patients at autopsy, to better understand what caused a patient's illness and death for research purposes," explained Dr. Michael Osborn, co-author of the study, Consultant Pathologist at Imperial College Healthcare NHS Trust, and an Honorary Clinical Senior Lecturer at Imperial College London.

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Post-Mortem Findings on COVID-19 Patients

Among the patients examined, researchers found out that high blood pressure (hypertension) and chronic obstructive pulmonary disease (COPD) most commonly contributed to the COVID-19 death. COPD refers to an umbrella of respiratory conditions causing breathing difficulties.

All of the patients had a fever and at least two COPD symptoms, mostly cough and shortness of breath, at the onset of the coronavirus disease. Researchers noted that most of the patients died within three weeks, with varying treatments administered to them.

They reported that the most consistent findings in the cohort were diffuse alveolar damage (DAD), thrombosis, hemophagocytosis, and immune cell depletion, citing that unexpected pathologies were also identified.

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Among the findings, DAD was the most prominent in the patients examined. DAD is the generalized term to the injury sustained by the lung tissues. Next, nine of the ten patients had some form of a blood clot, which causes heart attack and strokes when clots block the passage of blood to the organs. Eight patients experienced thrombosis in their lungs, five in the heart, and four in the kidneys.

This study supports earlier theories that COVID-19 caused blood circulation problems, with blood-thinning medication being a recommended part of COVID treatment plans.

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