Correlation of morphological abnormality in Peripheral blood smears with disease severity and mortality in Covid 19

Introduction: COVID 19 pandemic, caused by SARS –CoV-2 virus causes flu like mild symptoms to severe acute respiratory syndrome. Pathogenesis is Immune system deregulationand is haracterized by the presence of lymphopenia in the peripheral blood smears. The clinical laboratory plays an important role in the diagnosis, treatment and prognosis of coronavirus patients. Aims &Objectives: • To describe the morphological changes in white blood cells, red blood cells, and platelets in the peripheral blood smears of COVID 19 positive patients. • To perform a blinded study on morphological parameters by two pathologists and study the inter-observer variability. •To correlate morphological changes with the haematological parameters obtained on complete blood counts. • To study the association of morphological changes with disease severity and survivor status of the patients Material &Methods: A total of 100 adults,aged more than 18 years who tested positive on RT PCR were enrolled for the study. Based on the symptoms, the patients were divided into two groups: mild to moderate and severe. Venous blood sample was collected and peripheral blood smearswere examined by pathologists. Results: The most characteristic haematological findings noted in peripheral blood smears inCOVID 19 patients were leucocytosis, neutrophilia, lymphopenia, monocytosis and thrombocytopenia.In neutrophils both nuclear as well as cytoplasmic abnormalities were noted. Nuclear abnormalities ranged from ring shaped nucleus tohypolobular neutrophils termed as pseudo pelgerhuet anomaly to presence of band forms. Cytoplasmic abnormality included presence of dark blue granulation which is similar to toxic granules. Apoptotic bodies were also noted. In platelets, we observed strikingly a unique feature showing presence of large platelets and increased frequency of platelet clumps along with normal to low platelet counts. Conclusions: These routinely used, non-invasive, quick and cost-effective tests for morphological details along with routine CBC parameters can play an important role which will have great clinical relevance helping to predict the disease progression and severity at an early stage aiding in patient triage and management.

An analysis of hematological, coagulation and biochemical markers in COVID-19 disease and their association with clinical severity and mortality: an Indian outlook

BACKGROUND: The "cytokine storm" (CS) in COVID-19 leads to the worst stage of illness which can be controlled only with timely intervention. There is an urgent need to identify laboratory markers of disease progression for optimum allocation of resources in developing countries like India. METHODS: A cross-sectional study was conducted on 100 COVID-19 positive patients over two months. The cases were sub-classified based on disease severity into mild to moderate (n=61), severe (n=26) and very severe (n=13) and into survivors (n=85) and non-survivors (n=15) based on survivor status. These patients were tested for hematological parameters (total blood lymphocyte counts, NLR, PLR, platelet indices etc.), coagulation markers (D-dimer, fibrin degradation products (FDP), fibrinogen etc.) and biochemical markers (LDH, ferritin, IL-6, procalcitonin, hs-CRP). RESULTS: Statistically significant differences were observed in hematological variables (ANC, NLR and ESR), coagulation parameters (D-dimer, FDP, fibrinogen and thrombin time) and biochemical markers (LDH, ferritin, IL-6, procalcitonin and hs-CRP) with regard to subcategories based of disease severity as well as survivor status. There was strong correlation between NLR, D-dimer, IL-6, procalcitonin and ferritin. IL-6 emerged as the single best marker of disease severity (AUC: 0.997, P=0.00), however procalcitonin, LDH, D-dimer, FDP and NLR could also predict severe disease with a good sensitivity and specificity. CONCLUSION: To conclude, study demonstrates a plethora of biomarkers which could be utilized to accurately identify the hyperinflammation and tissue damage reminiscent of cytokine storm in COVID-19 patients so that timely, safe, and effective therapies can be administered to prevent progression and potentially reduce mortality.

Correlation of Morphological Abnormalityin Peripheral Blood Smears with Disease Severityand Mortality in COVID 19

Introduction: COVID 19 pandemic, caused by SARS CoV-2 viruscauses flu like mild symptoms to severe acute respiratory syndrome.Pathogenesis is Immune system dysregulation and is characterised bythe presence of lymphopenia in the peripheral blood smears. Theclinical laboratory plays an important role in the diagnosis, treatmentand prognosis of coronavirus patients.Aims &Objectives: To describe the morphological changes in white blood cells, redblood cells, and platelets in the peripheral blood smears of COVID19 positive patients. To correlate morphological changes with the haematologicalparameters obtained on complete blood counts. To study the association of morphological changes with diseaseseverity and survivor status of the patients.Materials &Methods: A total of 100 adults, aged more than18 years who tested positive on RT PCR were enrolled for the study.Based on the symptoms, the patients were divided into two groups:mild to moderate and severe. Venous blood sample was collected andperipheral blood smears were examined by pathologists.Result: The most characteristic haematological findings noted inperipheral blood smears in COVID 19 patients were leucocytosis,neutrophilia, lymphopenia, monocytosis and thrombocytopenia. Inneutrophils both nuclear as well as cytoplasmic abnormalities werenoted. Nuclear abnormalities ranged from ring shaped nucleus tohypolobular neutrophils termed as pseudo pelgerhuet anomaly topresence of band forms. Cytoplasmic abnormality included presenceof dark blue granulation which is similar to toxic granules. Apoptoticbodies were also noted. In platelets, we observed strikingly a uniquefeature showing presence of large platelets and increased frequency ofplatelet clumps along with normal to low platelet counts. We notedsignificant positive correlation in morphology of neutrophils andplatelets among severe, mild to moderate groups and survivors or nonsurvivors groups.Conclusions: These routinely used, non-invasive, quick and costeffective tests for morphological details along with routine CBCparameters can play an important role which will have great clinicalrelevance helping to predict the disease progression and severity at anearly stage aiding in patient triage and management.

Association of hematologic biomarkers and their combinations with disease severity and mortality in COVID-19- an Indian perspective

Background: COVID-19 is a systemic viral infection with a significant impact on the hematopoietic system, hemostasis as well as immune system. It would be of utmost importance to explore if the most routinely used tests could serve as an aid in determining patient’s clinical status or predicting severity of the disease. Methods: A pro

Hematologic biomarkers in COVID-19: Correlation with disease severity and mortality

Aims & Objectives: The aims and objectives of present study were to evaluate the various Hematological parameters including Neutrophil- lymphocyte ratio (NLR), Platelet-lymphocyte ratio (PLR) in COVID- 19 patients and controls and to study correlation of these parameters with each other and with disease severity. Patients/Materials & Methods: A prospective cross sectional study was conducted on 506 Covid-19 positive patients and 50 controls over a period of two months (June to July 2020). The cases were subclassified based on disease severity into mild to moderate (n = 337), severe (n = 118) and very severe (n = 51) and into survivors (n = 473) and non survivors (n = 33) based on survivor status. Results: There were statistically significant differences in WBC count, Absolute neutrophil count (ANC), Absolute lymphocyte count (ALC), absolute monocyte count (AMC), NLR, PLR, RDW SD and RDW CV between covid cases vs controls;among the clinical subgroups and among the survivors and non survivors. There was a significant strong positive correlation between various parameters, that is, NLR and MLR (r: 0.852, p = 0), MPV and PDW (r: 0.912, p = 0), MPV and PLCR (r:0.956, p = 0), PDW and PLCR (r:0.893, p = 0). NLR (AUC: 0.676, p = 0) was the best single parameter and NLR + RDW-CV was best combination parameter as per area under curve (0.871) of ROC to distinguish severe from mild to moderate disease. Discussion & Conclusion: Leucocytosis, neutrophilia, lymphopenia and monocytosis were characteristic while NLR and NLR + RDWCV emerged as the most effective single and combination CBC parameters in distinguishing mild to moderate and severe cases respectively.