Hematological changes associated with COVID‐19 infection

Abstract

Background The unresolved COVID‐19 pandemic considerably impacts the health services in Iraq and worldwide. Consecutive waves of mutated virus increased virus spread and further constrained health systems. Although molecular identification of the virus by polymerase chain reaction is the only recommended method in diagnosing COVID‐19 infection, radiological, biochemical, and hematological studies are substantially important in risk stratification, patient follow‐up, and outcome prediction. Aim This narrative review summarized the hematological changes including the blood indices, coagulative indicators, and other associated biochemical laboratory markers in different stages of COVID‐19 infection, highlighting the diagnostic and prognostic significance. Methods Literature search was conducted for multiple combinations of different hematological tests and manifestations with novel COVID‐19 using the following key words: “hematological,” “complete blood count,” “lymphopenia,” “blood indices,” “markers” "platelet" OR "thrombocytopenia" AND "COVID‐19," "coronavirus2019," "2019‐nCoV," OR "SARS‐CoV‐2." Articles written in the English language and conducted on human samples between December 2019 and January 2021 were included. Results Hematological changes are not reported in asymptomatic or presymptomatic COVID‐19 patients. In nonsevere cases, hematological changes are subtle, included mainly lymphocytopenia (80.4%). In severe, critically ill patients and those with cytokine storm, neutrophilia, lymphocytopenia, elevated D‐dimer, prolonged PT, and reduced fibrinogen are predictors of disease progression and adverse outcome. Conclusion Monitoring hematological changes in patients with COVID‐19 can predict patients needing additional care and stratify the risk for severe course of the disease. More studies are required in Iraq to reflect the hematological changes in COVID‐19 as compared to global data.

Hematologic Complications in Patients Hospitalized with COVID-19 Infection

“…Many cases of severe COVID-19 have been characterized by dysregulated inflammation and coagulation activation [ 2 ]. Pro-inflammatory cytokine secretion, microangiopathic vasculopathy, and B-cell secretion of specific SARS-CoV-2 antibodies in infected cells are induced by the SARS-CoV-2 S (spike) protein binding to ACE2 receptors in epithelial cells of the respiratory tract [ 9 ].…”

“…Therefore, COVID diagnosis and disease severity must be determined early so extended pharmacological thromboprophylaxis with low-molecular-weight heparin (LMWH) regimen can be started early in the disease course. By doing so, appropriate management can be planned before at-risk patients develop organ failure or shock [ 2 ].…”

“…Although COVID-19 has been well-studied and characterized, the pathophysiology underlying disease severity and progression remains unclear [ 1 ]. Although COVID-19 is primarily a disease of the lower respiratory tract, we now know that it can affect a wide range of systems in the body, including the hematologic system [ 2 ]. However, there is conflicting evidence regarding the correlation between the severity of COVID-19 disease and lymphopenia, neutrophilia, and thrombocytopenia; lymphocytosis and neutropenia have been reported in 22% of 486 hospitalized children and 16.7% of pregnant women, respectively, and prevalence of thrombocytopenia varies from 5 to 41.7% in COVID-19 patients [ 2 , 3 , 4 , 5 ].…”

Coronary Heart Disease and Coronavirus Disease 2019: Pathogenesis, Epidemiology, Association with Myocardial Revascularization

“…The severe course of coronavirus infection is characterized by an increase in some biochemical parameters responsible for inflammatory reactions (ferritin and C-reactive protein), thrombus formation (D-dimer, fibrinogen, and prolongation of PT), and damage to myocardial muscle tissue (troponin and creatine phosphokinase). Serum ferritin levels are important in mediating the immune response that is elevated in severe cases of COVID-19, and elevated ferritin levels can trigger a cytokine storm with direct immunosuppressive and pro-inflammatory effects [33], [34], [35]. A study conducted by Spanish scientists among patients with a history of myocardial revascularization (stenting) who underwent COVID-19 described cases of stent thrombosis, which, according to their hypothesis, are associated with hypercoagulability.…”

Severe Thrombocytopenia as a Manifestation of COVID-19 Infection

“…Clinical manifestations of COVID-19 infection can range from an asymptomatic clinical form to acute respiratory distress depending on the virus gateway, viral load, host immunity, and existing comorbidities [1]. Clinical respiratory and gastrointestinal manifestations are the most common in COVID-19-positive patients, but extrapulmonary manifestations such as neurological, dermatological, and cardiovascular have also been reported, usually associated with respiratory manifestations and only rarely present independently of the respiratory infection [2].…”