tetano
Editor, Senior Moderator
J Med Virol
. 2022 Apr 25.
doi: 10.1002/jmv.27793. Online ahead of print.
Comparison of haematologic abnormalities between hospitalized Coronavirus disease 2019 (COVID-19) positive and negative patients with correlation to disease severity and outcome
Swasti Jain[SUP] 1 [/SUP], Rachana Meena[SUP] 1 [/SUP], Vijay Kumar[SUP] 1 [/SUP], Ranvinder Kaur[SUP] 2 [/SUP], Umesh Tiwari[SUP] 1 [/SUP]
Affiliations
Abstract
Introduction: Peripheral blood smear (PBS) changes in Coronavirus disease 19 (COVID-19) are diverse and have been reported in literature in the form of case series with relatively smaller sample size and with a handful of studies showing association between peripheral blood smear and clinical severity.
Aims: This study aims to highlight the numerical and morphological changes in peripheral blood of COVID-19 patients and to compare the same in ICU and non-ICU settings as well as with disease severity and outcome.
Methods: The study included 80 COVID-19 positive (41 ICU and 39 non-ICU) patients and 32 COVID-19 negative ICU patients. Complete blood counts and PBS findings were studied and scored by two pathologists blindfoldedly.
Results: Absolute lymphocyte count (ALC) and absolute eosinophil count (AEC) were significantly lower in COVID-19 positive cases as compared to COVID-19 negative group (p=0.001 & p=0.001). COVID-19 positive group showed significant left myeloid shift (p=0.021), Dohle bodies (p=0.025) with significant prominence of acquired pseudo-Pelger-Huët anomaly, ring shaped neutrophils, monolobate neutrophils and plasmacytoid lymphocytes as compared to control group (p=0.000,p=0.009, p=0.046 & p=0.011 respectively). The overall mean White blood cell (WBC) counts were higher in COVID-19 positive ICU patients as compared to non-ICU COVID patients with significant shift to left, presence of ring shaped neutrophils, monocyte vacuolation and large granular lymphocytes (p=0.017, p=0.007, p=0.008 & p=0.004 respectively). Deceased group showed significantly higher WBC count (p=0.018) with marked neutrophilia (p=0.024) and toxic granulation (p=0.01) with prominence of monocyte vacuolization, ring shaped neutrophils, large granular lymphocytes and reactive lymphocytes.
Conclusion: Parameters like myeloid left shift, ring shaped neutrophils, monocyte vacuolation and large granular lymphocytes emerged as highly sensitive markers of disease severity. Therefore, serial CBC with comprehensive PBS analysis should be done in every newly diagnosed hospitalized COVID -19 patient which potentially predicts the course of disease. This article is protected by copyright. All rights reserved.
Keywords: COVID-19; Large granular lymphocytes; Morphology; Peripheral Blood Smear; Ring shaped neutrophils.
. 2022 Apr 25.
doi: 10.1002/jmv.27793. Online ahead of print.
Comparison of haematologic abnormalities between hospitalized Coronavirus disease 2019 (COVID-19) positive and negative patients with correlation to disease severity and outcome
Swasti Jain[SUP] 1 [/SUP], Rachana Meena[SUP] 1 [/SUP], Vijay Kumar[SUP] 1 [/SUP], Ranvinder Kaur[SUP] 2 [/SUP], Umesh Tiwari[SUP] 1 [/SUP]
Affiliations
- PMID: 35467029
- DOI: 10.1002/jmv.27793
Abstract
Introduction: Peripheral blood smear (PBS) changes in Coronavirus disease 19 (COVID-19) are diverse and have been reported in literature in the form of case series with relatively smaller sample size and with a handful of studies showing association between peripheral blood smear and clinical severity.
Aims: This study aims to highlight the numerical and morphological changes in peripheral blood of COVID-19 patients and to compare the same in ICU and non-ICU settings as well as with disease severity and outcome.
Methods: The study included 80 COVID-19 positive (41 ICU and 39 non-ICU) patients and 32 COVID-19 negative ICU patients. Complete blood counts and PBS findings were studied and scored by two pathologists blindfoldedly.
Results: Absolute lymphocyte count (ALC) and absolute eosinophil count (AEC) were significantly lower in COVID-19 positive cases as compared to COVID-19 negative group (p=0.001 & p=0.001). COVID-19 positive group showed significant left myeloid shift (p=0.021), Dohle bodies (p=0.025) with significant prominence of acquired pseudo-Pelger-Huët anomaly, ring shaped neutrophils, monolobate neutrophils and plasmacytoid lymphocytes as compared to control group (p=0.000,p=0.009, p=0.046 & p=0.011 respectively). The overall mean White blood cell (WBC) counts were higher in COVID-19 positive ICU patients as compared to non-ICU COVID patients with significant shift to left, presence of ring shaped neutrophils, monocyte vacuolation and large granular lymphocytes (p=0.017, p=0.007, p=0.008 & p=0.004 respectively). Deceased group showed significantly higher WBC count (p=0.018) with marked neutrophilia (p=0.024) and toxic granulation (p=0.01) with prominence of monocyte vacuolization, ring shaped neutrophils, large granular lymphocytes and reactive lymphocytes.
Conclusion: Parameters like myeloid left shift, ring shaped neutrophils, monocyte vacuolation and large granular lymphocytes emerged as highly sensitive markers of disease severity. Therefore, serial CBC with comprehensive PBS analysis should be done in every newly diagnosed hospitalized COVID -19 patient which potentially predicts the course of disease. This article is protected by copyright. All rights reserved.
Keywords: COVID-19; Large granular lymphocytes; Morphology; Peripheral Blood Smear; Ring shaped neutrophils.