Background and aims : COVID-19 is a multi-system disease, with coagulation abnormalities. D-dimer levels are increased in this disease. We aimed to determine the association of D-dimer levels and mortality and to establish its optimal cut off values in predicting mortality. Association of D-dimer levels with Diabetes Mellitus has also been established. Methods : Information on 483 patients with confirmed COVID-19 was retrospectively collected and analyzed. The optimal D-dimer cutoff point and C-statistic of routine tests both on admission and during hospital stay were evaluated by receiver operator characteristic (ROC) curve. Results : The D-dimer elevation (≥0.50 μg/mL) was seen in 80.1% of the hospitalized patients. D-dimer level ≥2.01 μg/mL was a significant predictor of subsequent deaths ( P < 0.01; HR, 3.165; 95% CI, 2.013–4.977). The high D-dimer values (≥0.50 μg/mL) were observed in 72 of the 75 (96%) cases with a fatal outcome. Median D-dimer values among non-survivors was 6.34 μg/mL and among survivors it was 0.94 μg/mL. A higher proportion of fatal outcomes occurred in patients with underlying disease (89.0%), most prominent of which was Diabetes Mellitus (66%). The median D-dimer value was found to be significantly high in Diabetic patients (1.68 μg/mL). Conclusions : Among the measured coagulation parameters, D-dimer during hospital stay had the highest C-index to predict in-hospital mortality in COVID-19 patients. D-dimer value ≥ 2.01 μg/mL can effectively predict in-hospital mortality in patients with COVID-19. A significant association of increased D-dimer level has been found with Diabetes Mellitus and elderly age.

Bernard-Soulier syndrome (BSS) is a rare autosomal recessively inherited bleeding disorder. Pregnancy in patients with BSS is characterized by ante-, intra-, or postpartum haemorrhage, which may be delayed and severe. There is no consensus in the management of BSS in pregnancy and so far only 16 pregnancies in nine patients have been described. We report a further three pregnancies in two women with the syndrome. We also outline our management of pregnant patients with BSS.