Peripheral Blood Smear Morphology- A Red Flag in COVID-19

Abstract

Covid-19 pandemic has affected the whole word medically, economically and emotionally. It is being considered as the biggest pandemic after the Spanish flu, with very high degree of morbidity and mortality in those with complications. The diagnostic and treatment criteria of this novel virus are being updated frequently as nothing much is known about it. This highlights the importance of hematology lab parameters in Covid diagnosis and prediction of disease progression. Multiple studies on complete blood counts and it’s derived parameters have been conducted in patients of Covid-19 however limited literature is available which discusses the morphology of circulating blood cells in Covid-19 cases. This short communication is presented with the purpose of highlighting the peripheral blood findings of 50 lab confirmed Covid-19 cases admitted at Super Specialty Pediatric Hospital and Post Graduate Teaching Hospital, NOIDA.

Changes in peripheral blood in SARS CoV‐2 patients and its clinico‐pathological correlation: A prospective cross‐sectional study

“…In the present study, the findings observed in CBC were lymphopenia (22%), monocytopenia (20%) and thrombocytopenia (48%) with neutrophilia (16%). These corroborated with findings reported by Singh S et al, Luke F, et al and Singh A 5,20,21 . Data by Luke F et al 5 were also in concert with present findings albeit with higher percentages of reported lympho‐/mono‐cytopenia, thrombocytopenia and leucocytosis.…”

“…These corroborated with findings reported by Singh S et al, Luke F, et al and Singh A. 5 , 20 , 21 Data by Luke F et al 5 were also in concert with present findings albeit with higher percentages of reported lympho‐/mono‐cytopenia, thrombocytopenia and leucocytosis. In a solitary case report by Singh A et al on morphology of COVID‐19‐affected cells in PBS, similar findings of neutrophilia with relative lymphocytopenia and monocytopenia have been documented.…”

Myriad of hematological manifestations in COVID-19 infected paediatric age group: our experience

“…18 Also noted were large granular lymphocytes, reactive monocytoid and plasmacytoid forms and blastoid forms, activated monocytes with large bizarre forms, vacuoles and granules. 18,19 In a study by Zhang et al by analysing monocyte subset it was shown that the peripheral smear in COVID-19 is different from any other viral illness. 20 More recent updates suggest that cytokine storm and hyperinflammation which is seen in COVID-19 infection can lead to such quantitative and qualitative abnormalities in hematological parameters, possibly in the form of secondary hemophagocytic lymphohistiocytosis, leading to possibility of relapse or fatal multi-organ failure.…”

Morphological alterations in peripheral blood smears of covid 19 patients

“…Alteration in morphology of cells of the peripheral blood in COVID-19 as is evident by few studies [9][10][11][12][13]. In a study of 28 patients with confirmed COVID-19 infection with varying degrees of severity, morphological and functional changes of monocytes/ macrophages were noted using wright stained smears and flow cytometry, that was predictive of the severity of disease, likelihood of ICU admission, length of hospital stay and full recovery [9] Singh et al in his case report of COVID 19 patient, found following changes in peripheral blood smear.…”