Correspondence

SARS in Hong Kong

N Engl J Med 2003; 349:708-709August 14, 2003

Article

To the Editor:

Lee et al. (May 15 issue)1 describe the clinical and laboratory features of 138 cases of suspected severe acute respiratory syndrome (SARS) in Hong Kong. It is striking that 44.8 percent of the patients had thrombocytopenia, 45.0 percent had elevated levels of D-dimers, and 42.8 percent had a prolonged activated partial-thromboplastin time. This combination suggests the presence of a form of disseminated intravascular coagulation2 or pulmonary-induced coagulation and fibrin polymerization with consumption of platelets and clotting factors. Elevated D-dimer levels have also been reported in patients with acute lung injury and in patients with the acute respiratory distress syndrome.3 We suggest that patients with SARS who have elevated D-dimer levels might need anticoagulant therapy or fibrinolytic therapy such as plasminogen activators,4 activated protein C, soluble thrombomodulin, antithrombin, tissue factor–pathway inhibitor, activated factor VII–pathway inhibitor, heparin, or low-molecular-weight heparin5 in order to reverse intraalveolar coagulation, microthrombi formation, and alveolar and interstitial fibrin deposition.6 Such reversals might improve survival.5

Ya Ping Wu, Ph.D.
University Medical Center, 3584 CX Utrecht, the Netherlands
ywu@azu.nl

Ran Wei, M.D.
Taishan Medical College, Taian, Shandong 271000, China

Philip G. de Groot, Ph.D.
University Medical Center, 3584 CX Utrecht, the Netherlands

6 References

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   Lee N, Hui D, Wu A, et al. A major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med 2003;348:1986-1994
   Full Text | Web of Science | Medline

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   Taylor FB Jr, Toh C-H, Hoots WK, Wada H, Levi M. Towards a definition, clinical and laboratory criteria, and a scoring system for DIC. Official communications of the Scientific and Standardization Committees and the International Society on Thrombosis and Haemostasis. Chapel Hill: University of North Carolina at Chapel Hill School of Medicine, 2003.
   

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   Wenzel C, Kofler J, Locker GJ, et al. Endothelial cell activation and blood coagulation in critically ill patients with lung injury. Wien Klin Wochenschr 2002;114:853-858
   Web of Science | Medline

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   Hardaway RM, Harke H, Tyroch AH, Williams CH, Vazquez Y, Krause GF. Treatment of severe acute respiratory distress syndrome: a final report on a phase I study. Am Surg 2001;67:377-382
   Web of Science | Medline

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   Laterre PF, Wittebole X, Dhainaut JF. Anticoagulant therapy in acute lung injury. Crit Care Med 2003;31:Suppl:S329-S336
   CrossRef | Web of Science | Medline

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   Gunther A, Ruppert C, Schmidt R, et al. Surfactant alteration and replacement in acute respiratory distress syndrome. Respir Res 2001;2:353-364
   CrossRef | Web of Science | Medline

Citing Articles (1)

Citing Articles

1. 1

   Y. P. Wu, Z. H. Liu, R. Wei, S. D. Pan, N. Y. Mao, B. Chen, J. J. Han, F. S. Zhang, U. Holmskov, Z. L. Xia, P. G. de Groot, K. B. M. Reid, W. B. Xu, G. L. Sorensen. (2009) Elevated Plasma Surfactant Protein D (SP-D) Levels and a Direct Correlation with Anti-severe Acute Respiratory Syndrome Coronavirus-specific IgG Antibody in SARS Patients. Scandinavian Journal of Immunology 69:6, 508-515
   CrossRef