C O V I D 1 9
14% require hospitalisation
6% have critical illness
4% mortality
ITU beds
Germany: 29.2 / 100,000 population
Portugal: 4.2 / 100,000 population
Secondary heamophagocytic lymphohistiocytosis (sHLH) --> hypercytokineamia --> Multi-organ failure (marked by elevated IL2, IL7, gCSF, Inf-alpha, TNF-alpha)
6% have critical illness
4% mortality
ITU beds
Germany: 29.2 / 100,000 population
Portugal: 4.2 / 100,000 population
Secondary heamophagocytic lymphohistiocytosis (sHLH) --> hypercytokineamia --> Multi-organ failure (marked by elevated IL2, IL7, gCSF, Inf-alpha, TNF-alpha)
HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS
HLH is a life-threatening clinical syndrome which represents the extreme end of the spectrum of a hyperinflammatory reaction
Hyperinflammation results from persistent stimulation of lymphocytes and histiocytes by triggers due to the inability to successfully eliminate the triggers and ergo terminate the immune response
The diagnosis HLH can be established if one of either 1 or 2 below is fulfilled
1. A molecular diagnosis consistent with HLH
2. Diagnostic criteria for HLH fulfiled (five out of the eight criteria below)
A) Initial diagnostic criteria (to be evaluated in all patients with HLH)
Fever
Splenomegaly
Cytopeanias (affecting >2 of 3 lineages in the peripheral blood):
Haemoglobin <90 g/L (in infants <4 weeks: hemoglobin <100 g/L)
Platelets <100 x 109/L
Neutrophils <1.0 x 109/L
Hypertriglyceridemia and/or hypofibrinogenemia:
Fasting triglycerides >3.0 mmol/L (i.e., >265 mg/dl)
Fibrinogen <1.5 g/L
Hemophagocytosis in bone marrow or spleen or lymph mode
B) New diagnostic criteria
Low or absent NK-cell activity (according to local laboratory reference)
Ferritin >500 g/L
Soluble CD25 (i.e. soluble IL-2 receptor) >2,400 U/ml
HScore (HScore for Reactive Hemophagocytic Syndrome)
HLH is a life-threatening clinical syndrome which represents the extreme end of the spectrum of a hyperinflammatory reaction
Hyperinflammation results from persistent stimulation of lymphocytes and histiocytes by triggers due to the inability to successfully eliminate the triggers and ergo terminate the immune response
The diagnosis HLH can be established if one of either 1 or 2 below is fulfilled
1. A molecular diagnosis consistent with HLH
2. Diagnostic criteria for HLH fulfiled (five out of the eight criteria below)
A) Initial diagnostic criteria (to be evaluated in all patients with HLH)
Fever
Splenomegaly
Cytopeanias (affecting >2 of 3 lineages in the peripheral blood):
Haemoglobin <90 g/L (in infants <4 weeks: hemoglobin <100 g/L)
Platelets <100 x 109/L
Neutrophils <1.0 x 109/L
Hypertriglyceridemia and/or hypofibrinogenemia:
Fasting triglycerides >3.0 mmol/L (i.e., >265 mg/dl)
Fibrinogen <1.5 g/L
Hemophagocytosis in bone marrow or spleen or lymph mode
B) New diagnostic criteria
Low or absent NK-cell activity (according to local laboratory reference)
Ferritin >500 g/L
Soluble CD25 (i.e. soluble IL-2 receptor) >2,400 U/ml
HScore (HScore for Reactive Hemophagocytic Syndrome)
ALI & ARDS
PaO2 / FiO2 in the absence of cardiac failure
ALI < 40 kPa <300 mmHg
ARDS < 26.7 kPa <200 mmHg
ALI < 40 kPa <300 mmHg
ARDS < 26.7 kPa <200 mmHg