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  • Secondary haemophagocytic lymphohistiocytosis in COVID-19: correlation of the autopsy findings of bone marrow haemophagocytosis with HScore

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Original research
Secondary haemophagocytic lymphohistiocytosis in COVID-19: correlation of the autopsy findings of bone marrow haemophagocytosis with HScore
  1. Claudia Núñez-Torrón1,
  2. Ana Ferrer-Gómez2,
  3. Esther Moreno Moreno2,
  4. Belen Pérez-Mies2,3,4,
  5. Jesús Villarrubia1,
  6. Sandra Chamorro5,
  7. Javier López-Jiménez1,3,
  8. J Palacios2,3,4,
  9. Miguel Piris-Villaespesa1,
  10. Mónica García-Cosío2,3,4
  1. 1 Hematology, Hospital Ramón y Cajal, Madrid, Spain
  2. 2 Pathology, Hospital Ramón y Cajal, Madrid, Spain
  3. 3 Faculty of Medicine, University of Alcalá de Henares, Madrid, Spain
  4. 4 CIBER-ONC, Instituto de Salud Carlos III, Madrid, Spain
  5. 5 Infectious Diseases, Hospital Ramón y Cajal, Madrid, Spain
  1. Correspondence to Dr Mónica García-Cosío, Pathology, Hospital Ramón y Cajal, Madrid 28034, Spain; monica.garciacosio{at}salud.madrid.org

Abstract

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.

  • COVID-19
  • bone
  • bone marrow

Data availability statement

All data relevant to the study are included in the article.

This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/jclinpath-2020-207337

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    Data availability statement

    All data relevant to the study are included in the article.

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    Footnotes

    • MP-V and MG-C are joint senior authors.

    • CN-T and AF-G are joint first authors.

    • Handling editor Mary Frances McMullin.

    • Contributors AF-G and CN-T have contributed equally as principal investigator. MG-C and MP-V have contributed equally as senior author. AF-G, EMM, BP-M, JP and MG-C participated in the autopsy procedure. CN-T, AF-G, MP-V and MG-C recollected the data. CN-T, AF-G, MP-V, MG-C and JP drafted the manuscript. All authors contributed to the final approved version of this manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.