A review on how to do hematology consults during COVID-19 pandemic

Abstract

The ongoing COVID-19 pandemic is the most trending and talked topic across the World. From its point of origin in Wuhan, China to clinical laboratory at NIH, a mere six-month-old SARS-CoV-2 virus is keeping the clinicians, and scientists busy at various fronts. However, COVID-19 is an emerging and evolving disease and each day brings in more data, new figures, and findings from the field of clinical practice. The role of hematologists has been increasingly recognized during the current pandemic because of several reasons. Most important of them are the characteristic hematological findings of COVID-19 patients that also have prognostic implications and that were not seen in other viral infections. The treatment of hematological complications in COVID-19 patients is very challenging given the critical care setting. There are interim and limited guidelines thus far due to the novelty of the disease. As this remains to be a quite fluid situation, all the appropriate medical societies including the major hematology bodies are proposing initial and interim guidelines (e.g. ASH guideline). This puts a hematologist on consult service in a dubious position where, he/she must tailor the recommendations on case to case basis. The purpose of this review is to provide the background context about the impact of COVID-19 on the blood system and to summarize the current interim guidelines to manage the associated hematological issues in COVID-19 infection.

Impact of COVID‐19 in Liver Disease Progression

“…The liver could also be impacted by the hypoxia and cytokine storm that follows SARS-CoV-2 infection, which is associated with multi-organ failure in some COVID-19 patients (1,33). The cytokine storm may also be implicated in the disseminated intravascular coagulation (DIC) and thrombocytopenia, which can worsen the DIC complications, observed in COVID-19 (34). Patients with COVID-19 have exhibited endotheliitis in the liver (35), fibrin microthrombi in liver sinusoids (36,37) and activation of the complement system (38).…”

Pneumomediastinum in COVID-19: A series of three cases and review of literature

“…The characteristic haematological abnormalities of COVID-19 patients have prognostic implications, and it is very challenging in managing these haematological complications in COVID-19. 1 There has been a significant increase in the number of intubations and need for mechanical ventilation during this pandemic and studies have shown that approximately 12%-24% of hospitalised patients required endotracheal intubation. 2,3 Pneumomediastinum (PM) also known as mediastinal emphysema is defined by the presence of air in the mediastinum.…”

“…The characteristic haematological abnormalities of COVID-19 patients have prognostic implications, and it is very challenging in managing these haematological complications in COVID-19. 1 …”

Sex-Dependent Performance of the Neutrophil-to-Lymphocyte, Monocyte-to-Lymphocyte, Platelet-to-Lymphocyte and Mean Platelet Volume-to-Platelet Ratios in Predicting Covid-19 Severity.

“…There is no doubt that patients with serious COVID-19 have dysregulated resistance reaction that permits viremia, thus ensuing hyperin ammation and cytokine storm. Neutrophilia is the expression of the cytokine reaction and a hyperimmunity in this disease [42]. Sex-driven differences in COVID-19 immune response are not fully understood [43].…”