First COVID Autopsy Series by SOM Pathologists Reveal New Cardiopulmonary Findings
Leslie Capo, Director of Information Services
LSU Health New Orleans pathologists performed the first series of autopsies on African
Americans who died from COVID-19 in New Orleans, and their findings provide new and
critical information to guide patient management. The findings are published in The
Lancet Respiratory Medicine, available post-embargo here.
“We found that the small vessels and capillaries in the lungs were obstructed by blood
clots and associated hemorrhage that significantly contributed to decompensation and
death in these patients,” reports senior author Richard Vander Heide, MD, PhD, Professor
and Director of Pathology Research at the School of Medicine. “We also found elevated
levels of D-dimers -- fragments of proteins involved in breaking down blood clots.
What we did not see was myocarditis, or inflammation of the heart muscle, that early
reports suggested significantly contributes to death from COVID-19.”
The patients were both males and females between 40 and 70 years old. All were African
American and many had a history of hypertension, obesity, and insulin-dependent type
II diabetes, and chronic kidney disease. In all cases, the patients presented to the
hospital approximately three days to one week after developing a mild cough and fever
(to 101-102° F), experiencing sudden respiratory decompensation or collapse at home.
Chest X-rays revealed “bilateral ground-glass opacities,” findings consistent with
acute respiratory distress syndrome (ARDS).
While the LSU Health New Orleans pathologists also found the same widespread damage
in the lung structures involved in gas exchange seen in the first SARS epidemic, the
small vessel clotting is a new finding that appears to be specific to COVID caused
by SARS-CoV-2.
“Our study presents a large series of autopsies within a specific demographic experiencing
the highest rate of adverse outcomes within the United States,” notes Sharon Fox,
MD, PhD, Associate Director of Research and Development in the Department of Pathology
at the School of Medicine.
The autopsies were performed at University Medical Center in New Orleans, which was
built after Hurricane Katrina. It is one of the few hospitals in the United States
equipped with an autopsy suite that meets CDC standards for performing autopsy of
COVID-19 positive patients safely.
“The key implications of our study include the discovery of a mechanism for severe
pathology within the African American population, likely extendable to all persons
with severe disease, and possibly a target for immediate therapeutic management,”
concludes Dr. Vander Heide. “The results may also be applicable to a broader demographic
experiencing severe COVID-19 disease. Management of these patients should include
therapy to target these pathologic mechanisms.”
In addition to Drs. Vander Heide and Fox, the LSU Health New Orleans team included
pathology residents Aibek Akmatbekov, MD; and Jack L. Harbert, MD. Guang Li and J.
Quincy Brown from Tulane also participated in the study.