Circulating microaggregates as biomarkers for the Post-COVID syndrome

Abstract

CoVID-19 can develop into Post-COVID syndrome of potentially high morbidity, with procoagulation and reactivation of dormant viral infections being hypothesized pathophysiological mechanisms. We report on a patient suffering from fatigue, post exertional malaise, pain and neurological symptoms as a consequence of the second CoVID infection. Using live confocal microscopy on native whole blood samples we detected microaggregates of thrombocytes, leukocytes and plasma proteins in peripheral blood. In addition, there was specific cellular immunological reactivity to EBV. Upon anticoagulatory and virustatic pharmacological therapy we observed dissolution of microaggregates and significant stable clinical remission. We suggest to consider circulating microaggregates as a morphological indicator of chronic post-COVID syndrome.

Keywords: Chronic fatigue; Coagulation; Post-CoVID.

Fig. 1

Real-time live confocal microscopy detects circulating microaggregates as a marker for Post-COVID associated symptoms. Circulating blood microaggregates (upper row, arrow) of a patient suffering from Post-COVID resolved after an anticoagulatory treatment step (lower row). Staining of DNA (blue, left panel) shows typical morphology of polymorphonuclear granulocytes and mononuclear lymphocytes and monocytes. The fine dust-like reactivity (blue) in the top row, especially in the center of aggregate, is mitochondrial DNA of thrombocytes. In red (center) wheat germ agglutinin (WGA) detects N-acetyl-d-glucosamine and N-acetyl-d-neuraminic acid residues on the surface of erythrocytes and within precipitates of proteins. Overlay is on the right, scale bar 15 µm.