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For last months, humanity has faced a formidable unknown enemy, which is presented as a new coronavirus infection. Despite the fact that the causative agents of new diseases appear at a certain frequency and that the virus SARS-CoV-2 has certain common properties with its predecessors, at the moment we are dealing with a new unknown pathogenesis of the development of severe complications in patients with risk factors. A final understanding of pathological process mechanisms is the goal of the scientific community. Summarizing research data from different countries, it became obvious that in severe cases of viral infection, we are dealing with a combination of the systemic inflammatory response syndrome, disseminated intravascular coagulation and thrombotic microangiopathy (TMA). Thrombotic microangiopathy is represented by a group of different conditions in which thrombocytopenia, hemolytic anemia, and multiple organ failure occur. The article reflects the main types of TMA, pathogenesis and principles of therapy. The main participants in the process are described in detail, including the von Willebrand factor and ADAMTS-13. Based on the knowledge available, as well as new data obtained from patients with COVID-19, we proposed possible models for the implementation of conditions such as sepsis, TMA, and DIC in patients with severe new coronavirus infection. Through a deeper understanding of pathogenesis, it will be possible to develop more effective diagnosis and therapy.

The pandemic of a new coronavirus infection COVID-19 has become a real challenge to humanity and the medical community and has raised a number of medical and social issues. From the currently available information on clinical cases of COVID-19, it follows that COVID-19 patients in critical condition have a clinical picture of disseminated intravascular coagulation (DIC), septic shock with the development of multiple organ failure, which justifies the anticoagulant therapy use in patients with COVID-19. In addition to isolating virus DNA from biological material and diagnosing SARS-CoV-2, the use of simple and easily accessible laboratory markers in the blood is necessary for the management of patients with COVID. If the activation of coagulation processes is sufficient enough, the consumption of platelets and blood clotting factors can be diagnosed by laboratory methods in the form of prolongation of routine blood clotting tests and increasing thrombocytopenia. Hyperfibrinogenemia, increased D-dimer, prolonged prothrombin time, thrombocytopenia, lymphopenia, leukocytopenia, increased interleukin 6, and ferritin are observed in most COVID-19 patients. The degree of increase in these changes correlates with the severity of the inflammatory process and is a prognostically unfavorable sign. In the article authors discuss laboratory monitoring that plays an essential role in this crisis, contributing to patient screening, diagnosis, as well as monitoring, treatment and rehabilitation.

The pathogenesis of bleeding in such patients has mixed pattern: besides vascular wall pathology coagulation deficiency plays some role. The preferred delivery method for such patients is caesarean section. Deep vaginal ruptures and serious hemorrhage accompany vaginal delivery.