b'blood clotting. As such, some primary lowblood-clotting pathology. In one study, 25%level and rouleaux formation of the RBCs platelet disorders require pro-coagulationofconvalescentCOVID-19patientswhoremains to be determined. Certainly, the measurestostopbleeding,whileotherwere four months past their acute COVID- presence of both should trigger the greatest conditionsfeaturingprimaryincreased19 infections demonstrated increased D-di- of concern for the development of signifi-thrombosis with the secondary rapid con- merlevels.Interestingly,theseD-dimercant chronic COVID-19 and post-COVID-19 sumption of platelet stores end up needingelevationswereoftenpresentwhilethevaccination complications.anticoagulation measures to stop that con- othercommonlaboratoryparametersof tinued consumption of platelets (Perry etabnormal blood clotting had returned toIs Persistent Spike Proteinal., 2021). Significant thrombosis post-vac- normal.Theseothertestsincludedpro- the Culprit?cination in the absence of an elevated D-di- thrombin time, partial thromboplastin time,Spike proteins are the spear-like append-mer level or low platelet count has alsofibrinogen level, and platelet count. Inflam- ages attached to and completely surround-been described (Carli et al., 2021). In plate- mationparameters,includingC-reactiveing the central core of the COVID-19 virus, lets taken from COVID-19 patients, plateletprotein and interleukin-6, typically also hadgivingthevirionsomewhatofaporcu-stickiness predisposing to thrombosis hasreturned to normal (Townsend et al., 2021). pine-like appearance. Upon binding to the been shown to result from spike proteinPersistent evidence of blood clotting (in- angiotensin converting enzyme 2 (ACE2) binding to ACE2 receptors on the plateletscreased D-dimer levels) in chronic COVID- receptors on the cell membranes of the tar-(Zhang et al., 2021). 19patientsmightbeareliablewaytoget cells, dissolving enzymes are released Of note, a D-dimer test that is elevateddetermine the persistent presence or pro- thatthenpermitentryofthecomplete due to increased blood clotting will usu- ductionoftheCOVID-19spikeprotein.COVID-19 virus into the cytoplasm, where ally only stay elevated for a few days afterAnother way, discussed below, might bereplication of the virus can ensue (Belou-the underlying pathology provoking thedark field microscopy to look for rouleauxzard et al., 2012; Shang et al., 2020).blood clotting has been resolved. Chronic,formation of the red blood cells (RBCs). AtConcern has been raised regarding the orlong-haulCOVID-19infections,the time of the writing of this article, thedissemination of the spike protein through-often demonstrate persistent evidence ofcorrelation between an increased D-dimerout the body after vaccination. Rather than H ealtHF reedomN ews /F all2021 21'