Introduction: Thrombosis occurs frequently in COVID-19. While the exact mechanism is unclear, 3 processes seem to play important roles in sepsis-related thrombosis and mortality: tissue factor expression on circulating monocytes and microparticles, hypercoagulability (increased clot firmness), and hypofibrinolysis. Rotational thromboelastometry is a point-of-care viscoelastic technique that uses the viscoelastic properties of blood to monitor coagulation. Using various assays, viscoelastometry could monitor this triad of changes in severely ill, COVID-19-positive patients. Similarly, with the increased incidence of coagulopathy, many patients are placed on anticoagulants, making management more difficult depending on the agents utilized. Viscoelastometry might also be used in these settings to monitor anticoagulation status and guide therapy, as it has in other areas. Case Presentation: We present a case series of 6 patients with different stages of disease and different management plans. These cases occurred at the height of the pandemic in New York City, which limited testing abilities. We first discuss the idea of using the NaHEPTEM test as a marker of tissue factor expression in COVID-19. We then present cases where patients are on different anticoagulants and review how viscoelastometry might be used in a patient on anticoagulation with COVID-19. Conclusion: In a disease such as COVID-19, which has profound effects on hemostasis and coagulation, viscoelastometry may aid in patient triage, disease course monitoring, and anticoagulation management.
The utilization of assisted reproductive technology (ART), particularly by same-sex female couples (SSFCs), has increased over the past few decades. Alongside the increase in use by lesbian women, there has also been an increase in the number of available treatment options. The process by which SSFCs make the various decisions associated with conceiving and parenting, however, has been largely overlooked. This review provides an overview of the reproductive treatments available to lesbian women and specifically highlights the “biological” and “social” obstacles they must overcome on their journey to parenthood. This review also describes how a relatively novel treatment strategy, co-in vitro fertilization, can give couples greater flexibility and provide them with the unique opportunity of a shared biological motherhood.
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