Keywords
How to Cite
Abstract
Background. Coronavirus disease (COVID-19) caused by the SARS-CoV-2 virus has caused a worldwide public health crisis and has a major impact on the hematopoietic system. Objective. To describe the alterations in hematological parameters and morphological abnormalities in blood cells of hospitalized patients with COVID-19. Materials and methods. A cross-sectional study was performed based on the review of 133 hemograms and peripheral blood films of patients older than 18 years hospitalized with COVID-19 between January and March 2021 at the Cayetano Heredia Hospital, Lima, Peru. Blood cell count was performed by hemogram and morphology by blood smear using Wright's staining technique. A descriptive analysis was performed based on frequencies. Results. 60.9% (n=81) were male. In the blood cell count, neutrophilia (65.4%), anemia (64.7%), leukocytosis (60.9%), lymphopenia (59.4%), eosinopenia (51.9%) and thrombocytosis (27.8%) were the most frequent alterations. In red cell morphology, anisocytosis (18.8%) was the most frequent alteration. At the level of white blood cell morphology, we observed toxic granulations (51.1%), neutrophil hypersegmentation (32.3%), reactive lymphocytes (15%) and acquired Pelger Hüet anomaly (APHA) (9%) and at the platelet level giant platelets (33.8%) was the most frequently observed alteration. Conclusions. Our study describes a variety of alterations in the count and morphology of peripheral blood cells in hospitalized patients with COVID-19.
References
Zhu N, Zhang D, Wang W, Li X, Yang B, Song J et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-33. doi:10.1056/NEJMoa2001017.
Novel Coronavirus (2019-nCoV): situation report, 1 [Internet]. World Health Organization. 2020 [cited 2023 Apr 28]. Available from: https://apps.who.int/iris/handle/10665/330760
Wan W. WHO declares a pandemic of coronavirus disease covid-19 [Internet]. Washington Post. 2020 [cited 2023 Apr 28]. Available from: https://www.washingtonpost.com/health/2020/03/11/who-declares-pandemic-coronavirus-disease-covid-19/
Minsa: Casos confirmados por Coronavirus Covid-19 ascienden a 272 364 en el Perú (Comunicado N° 147) [Internet]. Ministerio de Salud. 2020 [cited 2023 Apr 28]. Available from: https://www.gob.pe/institucion/minsa/noticias/189091-minsa-casos-confirmados-por-coronaviruscovid-19-ascienden-a-272-364-en-el-peru-comunicado-n-147
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507–13. doi: 10.1016/S0140-6736(20)30211-7.
Letícia S, Sousa L, das Graças M, Romana D, de Barros M. COVID-19: Review and hematologic impact. Clin Chim Acta. 2020;510:170–6. doi: 10.1016/j.cca.2020.07.016.
Cossarizza A, De Biasi S, Guaraldi G, Girardis M, Mussini C. SARS-CoV-2, the Virus that Causes COVID-19: Cytometry and the New Challenge for Global Health. Cytometry A. 2020;97(4):340–3. doi:10.1002/cito.a.24002.
She J, Jiang J, Ye L, Hu L, Bai C, Song Y. 2019 novel coronavirus of pneumonia in Wuhan, China: emerging attack and management strategies. Clin Transl Med. 2020;9(1):19. doi: 10.1186/s40169-020-00271-z.
Nath D, Madan U, Singh S, Tiwari N, Madan J, Agrawal R. CBC parameters and morphological alterations in peripheral blood cells in COVID-19 patients: Their significance and correlation with clinical course. International Journal of Health and Clinical Research. 2020;3(10):95–108.
Debuc B, Smadja D. Is COVID-19 a New Hematologic Disease? Stem Cell Rev Rep. 2021;17(1):4–8. doi:10.1007/s12015-020-09987-4.
Pozdnyakova O, Connell N, Battinelli E, Connors J, Fell G, Kim A. Clinical Significance of CBC and WBC Morphology in the Diagnosis and Clinical Course of COVID-19 Infection. Am J Clin Pathol. 2021;155(3):364–75. doi: 10.1093/ajcp/aqaa231.
Rahman A, Niloofa R, Jayarajah U, De Mel S, Abeysuriya V, Seneviratne S. Hematological Abnormalities in COVID-19: A Narrative Review. Am J Trop Med Hyg. 2021;104(4):1188–201. doi: 10.4269/ajtmh. 20-1536.
Zhang D, Guo R, Lei L, Liu H, Wang Y, Wang Y et al. Frontline Science: COVID-19 infection induces readily detectable morphologic and inflammation-related phenotypic changes in peripheral blood monocytes. J Leukoc Biol. 2021;109(1):13–22. doi: 10.1002/JLB.4HI0720-470R.
Guan W, Ni Z, Hu Y, Liang W, Ou C, He J et al. ClinicalCharacteristics of Coronavirus Disease 2019 in China.J Emerg Med. 2020;382(18):1708–20. doi: 10.1056/NEJMoa2002032.
Lippi G, Plebani M. The critical role of laboratory medicine during coronavirus disease 2019 (COVID-19) and other viral outbreaks. Clin Chem Lab Med. 2020;58(7):1063–9. doi: 10.1515/cclm-2020-0240.
Lab Values, Normal Adult: Laboratory Reference Ranges in Healthy Adults [Internet]. Medscape. 2021 [cited 2023 Apr 28]. Available from: https://emedicine.medscape.com/article/2172316-overview
Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med. 2020;46(5):846–8. doi: 10.1007/s00134-020-05991-x.
Daix T, Jeannet R, Hernandez A, Vignon P, Feuillard J, François B. Immature granulocytes can help the diagnosis of pulmonary bacterial infections in patients with severe COVID-19 pneumonia. Journal of Intensive Care. 2021;9(1):58. doi: 10.1186/s40560-021-00575-3.
Liu X, Zhang R, He G. Hematological findings in coroavirus disease 2019: indications of progression of disease. Ann Hematol. 2020;99(7):1421–8. doi: 10.1007/s00277-020-04103-5.
Huang G, Kovalic A, Graber C. Prognostic Value of Leukocytosis and Lymphopenia for Coronavirus Disease Severity. Emerg Infect Dis. 2020;26(8):1839–41.doi: 10.3201/eid2608.201160.
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506. https://doi.org/10.1016/S0140-6736(20)30183-5.
Yan X, Li F, Wang X, Yan J, Zhu F, Tang S et al. Neutrophil to lymphocyte ratio as prognostic and predictive factor in patients with coronavirus disease 2019: A retrospective cross-sectional study. J Med Virol. 2020;92(11):2573–81. doi: 10.1002/jmv.26061.
Zhang J, Dong X, Cao Y, Yuan Y, Yang Y, Yan Y et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy. 2020;75(7):1730–41. https://doi.org/10.1111/all.14238.
Outh R, Boutin C, Gueudet P, Suzuki M, Saada M, Aumaître H. Eosinopenia <100/μL as a marker of active COVID-19: An observational prospective study. J Microbiol Immunol Infect. 2021;54(1):61–8. doi:10.1016/j.jmii.2020.12.005.
Lippi G, Plebani M, Henry B. Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis. Clin Chim Acta. 2020;506:145–8. https://doi.org/10.1016/j.cca.2020.03.022.
Ranucci M, Ballotta A, Di U, Baryshnikova E, Dei M, Resta M et al. The procoagulant pattern of patients with COVID-19 acute respiratory distress syndrome. J Thromb Haemost. 2020;18(7):1747–51. https://doi.org/10.1111/jth.14854.
Gérard D, Ben Brahim S, Lesesve JF, Perrin J. Are mushroom-shaped erythrocytes an indicator of COVID-19? Br J Haematol. 2021;192(2):230. doi:10.1111/bjh.17127.
Zini G, d'Onofrio G. Coronavirus disease 2019 (COVID-19): Focus on peripheral blood cell morphology. Br J Haematol. 2023;200(4):404-419. doi:10.1111/bjh.18489.
Mehta P, McAuley D, Brown M, Sanchez E, Tattersall R, Manson J. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet.
;395(10229):1033–4. https://doi.org/10.1016/S0140-6736(20)30628-0.
Liu W, Li H. COVID-19: Attacks the 1-Beta Chain of Hemoglobin to Disrupt Respiratory Function and Escape Immunity by Capsid-Like System [Internet]. 2023 [cited 2023 Apr 28]. Available from: https://chemrxiv.org/engage/chemrxiv/article-details/63d134df6bc-5ca30b61a9d64
All material published in the journal HEMATOLOGÍA (electronic and print version) is transferred to the Argentinean Society of Hematology. In accordance with the copyright Act (Act 11 723), a copyright transfer form will be sent to the authors of approved works, which has to be signed by all the authors before its publication. Authors should keep a copy of the original since the journal is not responsible for damages or losses of the material that was submitted. Authors should send an electronic version to the email: revista@sah.org.ar