Objectives: To analyze whether leucopenia and lymphopenia a characteristic feature of children with COVID-19 and to find out its association with the disease severity. Methods: This was a descriptive cross-sectional study conducted at The Children’s Hospital Lahore from March 2020 to October 2020. All confirmed cases of COVID-19 infection and post-COVID MIS-C/Kawasaki Disease diagnosed on the basis of RT-PCR and Antibody test respectively were included. Complete blood and differential counts were performed on the day of admission. Results: Out of a total of 83 patients 60 (72%) were diagnosed as COVID-19 and 23 (28%) as post-COVID MIS-C/KD. The mean age of children was 7.0±4.3 years (95%CI: 6.07 - 8.75) with a male preponderance 51 (61%). Twenty (24%) children had an underlying comorbidity and 7 (8%) were surgical cases. Our case fatality rate was 5 (6%) and all children who died had an underlying comorbid condition. In both, COVID and MIS-C/KD the mean leukocyte count was (14.0 ± 12.5 vs 13.6 ± 6.9 x109/L), respectively (p=0.888). The mean lymphocyte count in children with COVID was (39.1 ± 21.4%). Patients with MIS-C/KD showed significantly higher levels of neutrophil count (76.5 ± 15.0%) as compared to children with COVID (52.0 ± 22.1%), absolute lymphocyte count was (5.02±4.81 vs 2.13±0.95 x109/L) in COVID and MIS-C respectively (p=<0.001). In 60 COVID-19 patients, the mean neutrophil lymphocyte ratio (NLR) in mild-moderate and severe-critical group was 2.00 and 5.08 respectively (p=0.009). Conclusion: The blood picture of COVID-19 in children does not show leukopenia. NLR was a prognostic factor to assess the severity in COVID-19 patients. The presence of an underlying comorbid conditions is significant a risk factor for poor outcome. doi: https://doi.org/10.12669/pjms.37.3.3848 How to cite this:Bari A, Ch A, Bano I, Saqlain N. Is leukopenia and lymphopenia a characteristic feature of COVID-19 in children?. Pak J Med Sci. 2021;37(3):---------. doi: https://doi.org/10.12669/pjms.37.3.3848 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: COVID-19 has presented with varied signs and symptoms with raised inflammatory markers among which D-dimers have been highlighted right from the beginning. Objectives were to analyze the relationship of D-dimers with the disease severity and outcome of children with COVID-19 and MIS-C in a developing country. Methods: It was a retrospective study conducted at a pediatric tertiary care hospital from March 2020 to November 2021. Clinical and laboratory details of confirmed COVID-19 and post COVID-19 MIS-C cases were recorded. D-dimer testing was performed using Chemiluminescence technique. It’s relation with disease severity and predictive role for in-hospital mortality were established by using ROC curves and cut-off values were calculated by using SPSS-24. Results: Of 272 children, 182 were of COVID-19 and 90 were of MIS-C. The mean age for COVID-19 and MIS-C patients was 5.4±4.8 years and 6.4±3.5 years respectively. Mild disease was seen in 33% cases while 17.6% were critical and 56.2% had some under lying comorbidity at presentation. Mean D-dimers were significantly higher in children with severe disease, who required ICU admission and non-survivors as compared to those with mild or moderate disease, not requiring ICU care and survivors, both in COVID-19 and MIS-C patients. ROC curve identified D-dimer value of ≥4.58 µg/ml (AUC=0.845) for COVID-19 cases and ≥4.73 µg/ml (AUC=0.682) for MIS-C patients as predictive of mortality. Conclusions: Raised D-dimer level is a reliable predictor of disease severity and outcome in children with COVID-19 and MIS-C. The D-dimer value of 4.58 µg/ml for COVID-19 cases and 4.73µg/ml for MIS-C patients was found to be the cut-off levels for predicting mortality
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