PT  - JOURNAL ARTICLE
AU  - Núñez-Torrón, Claudia
AU  - Ferrer-Gómez, Ana
AU  - Moreno Moreno, Esther
AU  - Pérez-Mies, Belen
AU  - Villarrubia, Jesús
AU  - Chamorro, Sandra
AU  - López-Jiménez, Javier
AU  - Palacios, J
AU  - Piris-Villaespesa, Miguel
AU  - García-Cosío, Mónica
TI  - Secondary haemophagocytic lymphohistiocytosis in COVID-19: correlation of the autopsy findings of bone marrow haemophagocytosis with HScore
AID  - 10.1136/jclinpath-2020-207337
DP  - 2022 Jun 01
TA  - Journal of Clinical Pathology
PG  - 383--389
VI  - 75
IP  - 6
4099  - http://jcp.bmj.com/content/75/6/383.short
4100  - http://jcp.bmj.com/content/75/6/383.full
SO  - J Clin Pathol2022 Jun 01; 75
AB  - Background Secondary haemophagocytic lymphohistiocytosis (sHLH) is characterised by a hyper activation of immune system that leads to multiorgan failure. It is suggested that excessive immune response in patients with COVID-19 could mimic this syndrome. Some COVID-19 autopsy studies have revealed the presence of haemophagocytosis images in bone marrow, raising the possibility, along with HScore parameters, of sHLH.Aim Our objective is to ascertain the existence of sHLH in some patients with severe COVID-19.Methods We report the autopsy histological findings of 16 patients with COVID-19, focusing on the presence of haemophagocytosis in bone marrow, obtained from rib squeeze and integrating these findings with HScore parameters. CD68 immunohistochemical stains were used to highlight histiocytes and haemophagocytic cells. Clinical evolution and laboratory parameters of patients were collected from electronic clinical records.Results Eleven patients (68.7%) displayed moderate histiocytic hyperplasia with haemophagocytosis (HHH) in bone marrow, three patients (18.7%) displayed severe HHH and the remainder were mild. All HScore parameters were collected in 10 patients (62.5%). Among the patients in which all parameters were evaluable, eight patients (80%) had an HScore >169. sHLH was not clinically suspected in any case.Conclusions Our results support the recommendation of some authors to use the HScore in patients with severe COVID-19 in order to identify those who could benefit from immunosuppressive therapies. The presence of haemophagocytosis in bone marrow tissue, despite not being a specific finding, has proved to be a very useful tool in our study to identify these patients.All data relevant to the study are included in the article.