Coronavirus disease 2019 (COVID-19) disease leads to a hypercoagulable state and associated with thrombotic events that can cause mortality and morbidity. Thrombotic events include both venous and arterial thrombosis. In this case report, we present a 68-year-old COVID-19 patient with multisystemic infarction who was admitted to the hospital by splenic infarction and later pulmonary embolism diagnosed during the stay in hospital despite anticoagulant use. It is important for emergency physicians to know that patients who had COVID-19 infection but not confirmed or not tested can visit the emergency department due to complications of COVID-19 infection such as thromboembolic events primarily.

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Objective: Despite vaccine and drug studies, convalescent plasma (CP) therapy remains an alternative treatment for coronavirus disease 2019 . In this study, we aimed to reveal the efficacy of CP therapy on mortality and the factors affecting it for the patients diagnosed with COVID-19 and acute respiratory distress syndrome (ARDS) which were followed in our intensive care unit (ICU). Material and Method:The data (demographic characteristics, the amount of CP used, PaO2/FiO2, leukocyte, neutrophil, lymphocyte, D-Dimer, C-reactive protein (CRP), procalcitonin, ferritin values, and the clinical findings) of the patients who were hospitalized in the ICU with the diagnosis of COVID-19 and received CP treatment between 20 March and 20 October 2020 were analyzed retrospectively. Data of deceased patients (n=29) and survivors (n=50) were compared with each other and logistic regression analysis was performed to investigate the relationship with mortality. Results: 79 patients who received 166 units of CP therapy after a mean of 13.45±3.6 days symptom onset, were identified. 96.2% of the patients had at least one concomitant disease. Mortality was observed in 29 (36.7%) of the patients. Mortality (5.1%) was less common in those receiving CP therapy within the first 14 days after the onset of symptoms. Patient age (p=0.041), neutrophil/lymphocyte ratio (p=0.004), CRP values (p=0.002), the number of comorbidities (p<0.001), PaO2/FiO2 ratio before CP (p=0.005), and the period when CP was first infused from symptom onset (p<0.001) had a statistically significant effect on mortality. Conclusion:CP can be safely used to treat COVID-19. However, its positive effect is less observed in patients with the advanced stage of the disease, progressive deterioration of oxygenation, and a high number of comorbidities. For this reason, starting CP treatment at an early stage may increase its effectiveness.

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