ABSTRACT
Introduction: Despite the fact that hematological alterations at the peripheral level are widely known, little is known about the alterations caused by COVID-19 at the bone marrow level. Objective: To determine the morphological alterations of the bone marrow caused by COVID-19. Material and methods: Systematic review and meta-analysis. Observational studies and reports and case series were included and editorials, reviews, letters to the editor were excluded. A search was performed in Pubmed, ScienceDirect and Scielo. The risk of bias was assessed using the NewCatell-Ottawa and Hassan Murad scales for case reports and series. The outcomes were the morphological parameters of the bone marrow. For the quantitative synthesis of the information, a proportion meta-analysis was performed using random effects in RStudio. Results: Hypercellularity occurred in 65% (95% CI: 51%-78%), maturation arrest of the myeloid series occurred in 57% (95% CI: 29%-83%). and the alteration of the M/E ratio occurred in 60% (95% CI: 46%-74%). Conclusion: The most frequent morphological alterations in the bone marrow were hypercellularity, arrest in myeloid maturation and alteration of the M/E ratio in patients with COVID-19. © 2022 Publicado por Cuerpo Médico Hospital Nacional Almanzor Aguinaga Asenjo.
ABSTRACT
Background: Changes in the coagulation profile have been associated with adverse clinical outcomes in patients with COVID-19. It is relevant to evaluate the changes in the coagulation profile and its impact on mortality from COVID-19 during the first and second waves in Peru. Aim(s): To evaluate the alterations and impact of the coagulation profile on mortality from COVID-19 during the first and second waves in Peruvians. Method(s): Retrospective cohort carried out at the "Dos de Mayo" National Hospital, Lima-Peru during the years 2020 and 2021. Peruvians over 18 years of age were included, excluding those with congenital hemostasis disorders, pneumonia caused by other agents and chronic users of anticoagulants. SARS-COV2 pneumonia was defined as infiltrate in lung TEM + positive RT-PCR. Alterations in coagulation parameters were determined by prolonged prothrombin time (PT>14s) and/or prolonged activated thromboplastin time (APTT>35s) and/or fibrinogen < 200 mg/dl and/or fibrinogen >400 mg/dl. dl. The sample was consecutive, reaching a sample of 300 patients from the first and 300 from the second wave. Data was collected and entered into a database and sent for analysis after quality control. Were presented summary measures for the qualitative and quantitative variables. A logistic regression equation was modeled to estimate the adjusted OR of the different coagulation parameters altered. The data were processed RStudio version 1.3.1093. Result(s): A total of 600 patients were included. Male was the most frequent sex during the two periods. Figure 1 shows the baseline characteristics. Fibrinogen < 200 mg/dl during the first wave was associated with a lower risk of death (OR: 0.07;95%-CI: 0.01, 0.90). Table 2 shows the results of the multivariate analysis. Conclusion(s): Apparently the changes in the coagulation profile caused by COVID-19 in Peruvians during the first and second waves were not associated with higher mortality. Low fibrinogen seemed to offer protection during the first wave. (Table Presented).
ABSTRACT
Objective: Determine the CALL SCORE's diagnostic accuracy for the prediction of ICU admission and death in patients hospitalized for COVID-19 pneumonia in a reference hospital in Peru. Methods: We performed an analytical cross-sectional observational study. We included patients with COVID-19 pneumonia treated at the "Dos de Mayo" National Hospital. Patients over 18 years old with a diagnosis confirmed by rapid or molecular testing were included. Those with an incomplete, illegible, or missing medical history and/or bacterial or fungal pneumonia were excluded. Data were extracted from medical records. The primary outcomes were mortality and admission to the ICU. The Call Score was calculated for each patient (4 to 13 points) and classified into three risk groups. Summary measures were presented for qualitative and quantitative variables. The area under the model curve and the operational characteristics (sensitivity, specificity) were calculated for the best cut-off point. Results: The Call Score reported an area under the curve of 0.59 (IC95%: 0.3 to 0.07), p = 0.43 for predicting death. However, for a cut-off point of 5.5, a sensitivity of 87% and a specificity of 65% were obtained. The area under the curve for ICU admission was 0.67 (95%CI: 0.3 to 0.07), p = 0.43;the 5.5 cut-off point showed a sensitivity of 82% and a specificity of 51%. Conclusions: The Call Score shows a low performance for predicting mortality and admission to the ICU in Peruvian patients.
ABSTRACT
Background: At the spinal level, SARS-CoV2 can compromise hematopoiesis, manifesting itself with cytopenias and there are only studies carried out in autopsies. Objective: to describe the morphological characteristics of the bone marrow of patients hospitalized for pneumonia due to COVID-19 at the Hospital Nacional “Dos de Mayo”. The study: Retrospective cross-sectional study carried out in patients diagnosed with COVID-19. The bone marrow readings were confirmed by a trained hematologist. Descriptive statistics were used for the quantitative and qualitative variables. Findings: 30 patients were included. The most frequent findings were: macrophages with cytophagocytosis (87%), hyperplasia with arrest in the maturation of myeloid progenitors (70%). 87% of the samples presented eosinophilia. Little or no evidence of platelet formation was observed in 57% of the samples. In 40%, 6% of plasma cells were found. Conclusion: SARS-CoV2 infection can generate spinal cord disorders. © Revista del Cuerpo Medico Hospital Nacional Almanzor Aguinaga Asenjo 2021.
ABSTRACT
Background : In SARS-COV2 infection, little is known about the changes in the coagulation profile that occur at admission that could predict future events such as bleeding or thrombosis. Aims : To establish the alterations in the coagulation profile of Peruvians with SARS-COV2 pneumonia at the time of their admission to a national referral hospital. Methods : A cross-sectional, retrospective study was carried out in Peruvians diagnosed with SARS-COV2 pneumonia admitted to the “Dos de Mayo” National Hospital, between June and November 2020. Pneumonia due to other agents were excluded. SARS-COV2 pneumonia was defined as: pulmonary TEM infiltrate + positive RT-PCR or positive rapid test (IgG and IgM). Alterations in the coagulation profile were determined by: prolonged prothrombin time (PT > 14 s) and / or prolonged activated thromboplastin time (APTT > 35 s) and / or fibrinogen <200 mg/dL. Additional variables such as age and sex were recorded. The sample was selected consecutively. The data were collected and entered into a database and sent for analysis after quality control. Frequencies and percentages were presented for the qualitative variables and summary measures for the quantitative variables. The data were processed RStudio version 1.3.1093. Results : A total of 100 patients were included. Male sex was the most frequent (63%) and the mean age was 54.74 ± 16 years. Seventy-one percent had PT prolongation and 36% had APTT prolongation. Only 5% had fibrinogen <200 mg/dL. Conclusions : There is a high prevalence of alterations in the coagulation profile, predominantly prolonged PT. It is relevant to evaluate in prospective studies whether these changes can predict future bleeding or thrombotic events.