Massive Pulmonary Embolism Complicating Coronavirus Disease 2019 (COVID-19) Pneumonia: A Case Report

Table 1

Blood work of patient at the time of admission, on the day of event, and on day 8 of admission.

Laboratory measure	Reference range	Day 1	Day 3 (at the time of APE)	Day 5	Day 8
White blood cell (x10^3/μL)	4.5-11	7.0	21.7	43.1	37
Red blood cell (x10^6/μL)	4.0-5.5	4.99	3.82	3.42	3.78
Hemoglobin (g/dL)	12-17	14.5	11.2	10.4	11.2
Hematocrit (%)	35-50	43.8	37.9	31.5	37.9
Platelet count (x10^3/μL)	150-400	179	131	158	130
ESR (mm/hr)	0-20	90	NA	NA	NA
Sodium (mmol/L)	137-146	137	141	136	135
Potassium (mmol/L)	3.5-5.3	4.0	5.3	4.2	3.9
Chloride (mmol/L)	98-107	99	94	96	98
Bicarbonate (mmol/L)	23-32	26	14	20	24
Blood urea nitrogen (mg/dL)	5-25	10	38	26	42
Creatinine (mg/dL)	0.6-1.4	1.0	1.8	2.4	3.0
Ferritin (ng/mL)	30-400	1181	47646	NA	NA
Aspartate amino transferase (AST) (U/L)	15-41	216	>7000	2985	295
Alanine aminotransferase (ALT) (U/L)	14-63	159	4828	3168	975
Troponin T (ng/mL)	≤0.03	<0.01	<0.01	0.77	0.66
NT-pro-B-type natriuretic peptide (NT-pro-BNP) (pg/mL)	0-900	90	8244	3601	2801
Total creatine kinase (U/L)	49-397	133	NA	NA	NA
Creatine kinase MB (CKMB) (ng/mL)	0-6.0	NA	25.3	4.6	2.5
C-reactive protein (CRP) (mg/dL)	<0.5	22.91	31.57	NA	4.93
C-reactive protein high sensitivity (mg/L)	1.0-3.0	162.7	NA	NA	NA
D-dimer, quantitative (μg/mLFEU)	<0.5	2.74	>20.0	NA	NA
Fibrinogen (mg/dL)	171-459	736	NA	NA	NA
PTT (sec)	23.3-35.9	28	38	75.4^#	78.2^#
Arterial blood gas (ABG)	Reference range	VC, FiO2 40%, PEEP 12, TV 400	VC, FiO2 100%, PEEP 14, TV 600	VC, FiO2 40% PEEP 10, TV 400	Spontaneous/CPAP FiO2 40%, PEEP 5
ABG (pH)	7.35-7.45	7.4	7.04	7.41	7.45
ABG partial pressure CO2 (mmHg)	35-45	46	63.5	35.1	38.2
ABG partial pressure O2 (mmHg)	80-100	215	70.6	189	113
ABG measured O2 saturation (%)	94-98	99	90	99.8	99

On hydrocortisone sodium succinate 50 mg intravenous every 8 hours. On continuous veno-venous hemodialysis. On intermittent hemodialysis. ^#On therapeutic heparin drip at 15.5 mls/hr (100 units/mL). DVT/PE anticoagulation protocol with heparin 25000 units/250 mL. Bolus dose of 80 units/kg. Initial infusion 18 units/kg/hr. Infusion adjusted to maintain target at PTT of 65-104 seconds. VC: volume control ventilation mode; FiO₂: fraction of inspired oxygen in percent; PEEP: positive end expiratory pressure in cmH₂O; TV: tidal volume in milliliter.