Title: Haematological and morphological alterations in peripheral blood cells of patients with COVID -19 infections
Authors: Monika Pangotra, Rashmi Aithmia, Isha Sharma
DOI: https://dx.doi.org/10.18535/jmscr/v10i6.12
Abstract
Introduction: COVID-19 infection is a highly communicable disease caused due to Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It is responsible for a widespread pandemic with millions of confirmed cases and numerous deaths, which are reported in almost all countries. Peripheral blood smears shows changes in the morphology and count of white blood cells (WBCs), as well as abnormalities of platelets. The most common hematological abnormalities seen in these patients include decreased lymphocytes, increased neutrophils, low eosinophils, as well as changes in the platelets.
Aims: The objective of this study was to evaluate changes in blood smears of COVID-19 patients which can help in the diagnosis and to a certain extent in the patient’s prognosis.
Materials and Methods: This study was performed on 52 patients diagnosed with COVID‐19 infection in district hospital Udhampur between April 2021 to June 2021. Blood samples were collected from the patients and examined for the estimation of hematological parameters and blood cell morphology.
Results: A total of 52 patients who were diagnosed with COVID-19 infection were enrolled in the study.WBC count was normal in 59.6% of the patients and leukocytosis was observed in 38.4%cases. In addition, differential WBC count indicated that 30.7% of cases had neutrophilia. Lymphopenia was found in 21.1% and 61.5 % had a low eosinophil count. The most notable morphologic changes were neutrophils with clumped chromatin, multiple abnormal nuclear shapes, pseudo-Pelger-Huet deformity, and smudged neutrophils’-shaped, fetus-like nuclei were noted with aberrant nuclear projections referred to as COVID nuclei. Atypical lymphocytes with deeply basophilic cytoplasm were seen in 19.8% of the cases. Activated monocytes were observed that demonstrated marked anisocytosis with significant cytoplasmic vacuolization and few granules.
Conclusion: The understanding of the hematological manifestations of SARS-CoV-2 is still evolving. This research identifies and describes a summary of morphological changes in peripheral blood cells of patients suffering fromCOVID-19. Knowledge of such morphologic changes in peripheral blood of affected leucocytes, if substantiated with larger studies, may help physicians diagnose in the absence of a negative RT-PCR or antibody results.
References
- Fan BE, Chong VCL, Chan SSW, Lim GH, Lim KGE, Tan GB, et al. Hematologic parameters in patients with COVID-19 infection. Am J Hematol. 2020;95(6):E131-4. doi: 1002/ajh.25774. [PubMed: 32129508].
- What the blood tests of a COVID-19 patient can tell us. UC Davis Health.Available:health.ucdavis.edu
- Zini G, Bellesi S, Ramundo F, d'Onofrio G. Morphological anomalies of circulating blood cells in COVID-19. Am J Hematol. 2020;95(7):870-2. doi: 1002/ajh.25824. [PubMed: 32279346]. [PubMed Central: PMC7262044].
- Bain BJ, Bates I, Laffan MA. Dacie and Lewis practical haematology e-book. Amsterdam, Netherlands: Elsevier Health Sciences; 2016.
- Hoffbrand AV, Steensma DP. Hoffbrand's essential haematology. 8th ed. New Jersey, United States: Wiley-Blackwell; 2019.
- Williamson DR, Albert M, Heels-Ansdell D, Arnold DM, Lauzier F, Zarychanski R, et al. Thrombocytopenia in critically ill patients receiving thromboprophylaxis: frequency, risk factors, and outcomes. Chest. 2013;144(4):1207-15. doi: 1378/chest.13-0121. [PubMed: 23788287].
- Bleeker JS, Hogan WJ. Thrombocytosis: diagnostic evaluation, thrombotic risk stratification, and risk-based management strategies. Thrombosis. 2011;2011:536062. doi: 1155/2011/536062. [PubMed: 22084665]. [PubMed Central: PMC3200282].
- World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Geneva, Switzerland: World Health Organization; 2011.
- Ahmed SS, Mohammed AA. Effects of thyroid dysfunction on hematological parameters: Case controlled study. Ann Med Surg (Lond). 2020;57:52-5. doi: 1016/j.amsu.2020.07.008. [PubMed: 32714526]. [PubMed Central: PMC7374177].
- Al-Ani A. Reactive lymphocytes in blood film of a covid-19 iraqi patient: A case report. infection. 2020;20(21):50.
- Finelli C, Parisi S. The clinical impact of COVID-19 epidemic in the hematologic setting. Adv Biol Regul. 2020;77:100742. doi: 1016/j.jbior.2020.100742. [PubMed: 32773103]. [PubMed Central: PMC7364141].
- Zhang D, Guo R, Lei L, et al.: COVID‐19 infection induces readily detectable morphological and inflammation‐related phenotypic changes in peripheral blood monocytes. J Leukoc Biol. 2021, 109:13-22. 1002/JLB.4HI0720-470R
- Zini G, Bellesi S, Ramundo F, d'Onofrio G: Morphological anomalies of circulating blood cells in COVID‐19. Am J Hematol. 2020, 95:870-872. 1002/ajh.25824
- Singh A, Sood N, Narang V, Goyal A: Morphology of COVID-19-affected cells in peripheral blood film. BMJ Case Rep. 2020, 13:e236117. 1136/bcr-2020-236117
- Mitra A, Dwyre DM, Schivo M, Thompson III GR, Cohen SH, Ku N, Graff JP: Leukoerythroblastic reaction in a patient with COVID-19 infection. Am J Hematol. 2020, 95:999-1000. 1002/ajh.25793
- Nazarullah A, Liang C, Villarreal A, Higgins RA, Mais DD: Peripheral blood examination findings in SARS-CoV-2 infection. Am J Clin Pathol. 2020, 154:319-329. 1093/ajcp/aqaa108
- Pozdnyakova O, Connell NT, Battinelli EM, Connors JM, Fell G, Kim AS: Clinical significance of CBC and WBC morphology in the diagnosis and clinical course of COVID-19 infection. Am J Clin Pathol. 2021, 155:364-375. 1093/ajcp/aqaa231
- Terpos E, Ntanasis-Stathopoulos I, Elalamy I, Kastritis E, Sergentanis TN, Politou M, et al. Hematological findings and complications of COVID-19. Am J Hematol. 2020;95(7):834-47. doi: 10.1002/ajh.25829. [PubMed: 32282949]. [PubMed Central: PMC7262337].