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1.
Biomed Res Int ; 2022: 4620037, 2022.
Article in English | MEDLINE | ID: covidwho-1706985

ABSTRACT

COVID-19 is a global pandemic viral infection that has affected millions worldwide. Limited data is available on the effect of COVID-19 on hematological parameters in Saudi Arabia. This study is aimed at examining the role of hematological parameters among COVID-19 patients admitted to King Khalid Hospital in Najran, Saudi Arabia. This is a retrospective, hospital-based study of 514 cases who were recruited during August to October 2020. 257 COVID-19 patients formed the study group, and a further 257 negative subjects formed the control group. Anemia was significantly elevated in positive subjects over controls (respectively, 64.2% and 35.8%), with patients 2.5 times more likely to be anemic (p < 0.01). Thrombocytopenia was higher in patients over controls (respectively, 62% and 38%), with patients ~1.7 times more likely to be thrombocytopenic (p < 0.01). Moreover, leukopenia was significantly higher in patients over controls (respectively, 71% and 29%), with positive subjects ~2.6 times more likely to be leukopenic. Our study results indicate that mild anemia associated with leukopenia may have diagnostic value for COVID-19. Careful assessment of hematological parameters, at baseline and throughout the disease path, will assist physicians in formulating personalized approaches to treatment and promptly offer intensive care to those in greater need.


Subject(s)
COVID-19/blood , COVID-19/complications , Adult , Aged , Anemia/virology , Female , Hospitalization , Humans , Leukopenia/virology , Lymphocyte Count , Male , Middle Aged , Retrospective Studies , Saudi Arabia , Thrombocytopenia/virology
2.
J Pediatr Hematol Oncol ; 43(7): 243-248, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1434557

ABSTRACT

Thrombocytopenia is noted in corona virus disease-2019 (COVID-19) with a prevalence of 5% to 41%, and has been observed to be associated with inferior outcomes. The pathogenesis of thrombocytopenia in COVID-19 is unique and differs from other viral syndromes in terms of clinical presentation and causative mechanisms. Platelets act as both targets and the initial defense against severe acute respiratory syndrome-coronavirus 2 and work in concert with the underlying thrombophilic mechanisms to modulate the final disease phenotype. Understanding these mechanisms may possibly allow targeting of a key component of COVID-19 pathogenesis. We provide a focused review of the current mechanisms implicated in development of thrombocytopenia in COVID-19 and therapeutic implications of the same.


Subject(s)
COVID-19/complications , SARS-CoV-2/isolation & purification , Thrombocytopenia/pathology , COVID-19/transmission , COVID-19/virology , Humans , Thrombocytopenia/epidemiology , Thrombocytopenia/virology
4.
J Med Virol ; 93(2): 1164-1170, 2021 02.
Article in English | MEDLINE | ID: covidwho-1196441

ABSTRACT

The current pandemic due to coronavirus disease 2019 (COVID-19) has posed an unprecedented challenge for the medical communities, various countries worldwide, and their citizens. Severe acute respiratory syndrome coronavirus 2 has been studied for its various pathophysiological pathways and mechanisms through which it causes COVID-19. In this study, we discussed the immunological impact of COVID-19 on the hematological system, platelets, and red blood cells.


Subject(s)
COVID-19/complications , COVID-19/immunology , Hemolysis/immunology , Thrombocytopenia/virology , Adolescent , Adult , Aged , Aged, 80 and over , Blood Platelets/pathology , COVID-19/blood , Erythrocytes/pathology , Female , Humans , Male , Middle Aged , Young Adult
5.
Int Immunopharmacol ; 93: 107390, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1059618

ABSTRACT

BACKGROUND: Exposure to viral or bacterial pathogens increases the number of neutrophils with a relative decrease in lymphocytes, leading to elevated neutrophil to lymphocyte ratio (NLR). This study aimed to investigate whether differences in NLR among real-time polymerase chain reaction (PCR)-positive and -negative patients presenting with a prediagnosis of COVID-19 pneumonia could be useful in the differential diagnosis. METHODS: The study included 174 patients admitted because of suspected COVID-19 infection between March and April 2020. Patients were divided into two groups: PCR-negative and PCR-positive. Hemogram, NLR, urea, creatinine, aspartate aminotransferase, alanine aminotransferase, bilirubin, ferritin, D-dimer, C-reactive protein, procalcitonin, troponin, and coagulation parameters were analyzed. RESULTS: On comparison of laboratory parameters between both groups at presentation, PCR-positive patients were significantly more likely to have leukopenia (p < 0.001), thrombocytopenia (p = 0.006), neutropenia (p < 0.001), lymphopenia (p = 0.001), and increased NLR (p = 0.003). Furthermore, PCR-positive patients showed significant elevations of ferritin (p = 0.012) and procalcitonin (p = 0.038) and significant lower potassium levels (p = 0.05). CONCLUSION: COVID-19 pneumonia has become a major global health problem. Early diagnosis and treatment of these patients are crucial, as COVID-19 pneumonia shows a rapid progression in most cases. Thus, leukopenia, thrombocytopenia, elevated NLR, and elevated ferritin may be useful as supplementary diagnostic tests in these patients, which may allow early initiation of treatment and may contribute to preventing progression in patients with abnormal results.


Subject(s)
COVID-19/blood , COVID-19/diagnosis , Coronavirus Infections/diagnosis , Adult , Aged , Aged, 80 and over , Coronavirus Infections/blood , Female , Ferritins/metabolism , Humans , Leukocyte Count , Leukocytes/pathology , Leukopenia/blood , Leukopenia/virology , Lymphocyte Count , Male , Middle Aged , Neutrophils/pathology , Platelet Count , Polymerase Chain Reaction , Retrospective Studies , SARS-CoV-2/isolation & purification , Thrombocytopenia/blood , Thrombocytopenia/virology
7.
Thromb Res ; 200: 1-8, 2021 04.
Article in English | MEDLINE | ID: covidwho-1032457

ABSTRACT

BACKGROUND: The novel coronavirus SARS-CoV-2, responsible for the 2019-2020 global (COVID-19) pandemic, is a respiratory virus associated with the development of thromboembolic complications and respiratory failure in severe cases. Increased risk of pulmonary embolism and thrombosis has been identified in COVID-19 patients, alongside accompanying elevations in potential prognostic biomarkers, including D-dimer, IL-6 and cardiac specific troponins. Our aim was to provide a scoping review of the available literature regarding thrombosis risk, other cardiovascular implications, and their biomarkers in COVID-19 to highlight potential disease mechanisms. METHODS: Authors conducted a literature search in PubMed using MeSH headings "disseminated intravascular coagulation", "pulmonary embolism", "thromb*", "stroke", "myocardial infarction" and "acute lung injury", as well as terms "COVID-19", "SARS-CoV-2", "2019 novel coronavirus" and "2019-nCoV". RESULTS AND CONCLUSIONS: COVID-19 disease is characterised by the interactions between hyperactive coagulation and complement systems - induced by hyper-inflammatory conditions, resulting in a pro-thrombotic state and diffuse tissue injury. There are several promising prognostic markers of disease severity, with D-dimer the most significant. The presence of thrombocytopenia appears to be a key indicator of patient deterioration. Further research is required to understand the underlying pathophysiology in COVID-19 and its implications in disease progression and patient management. Randomised trials are urgently needed to determine the safety of proposed therapeutic anticoagulation with heparin and the role for anti-platelet agents, such as Ticagrelor, in patient management.


Subject(s)
COVID-19/complications , Thromboembolism/virology , Thrombosis/virology , Biomarkers , Humans , Thrombocytopenia/virology
8.
BMC Infect Dis ; 20(1): 774, 2020 Oct 19.
Article in English | MEDLINE | ID: covidwho-873953

ABSTRACT

BACKGROUND: Thrombocytopenia was common in the coronavirus disease (Covid-19) patients during the infection, especially in severe COVID-19 patients, but was less in the non-severe Covid-19 patients. However, the platelet count would be restored after antivirus treatment. In this paper, we report continuous thrombocytopenia in a non-severe Covid-19 case after a negative nucleic acid test for Covid-19. CASE PRESENTATION: A non-severe COVID-19 patient had the platelet continuous decrease for several months after the SARS-CoV-2 nucleic acid turning negative, and without well response to the glucocorticoid. The dynamic change of platelet count followed that of the lymphocyte count. After excluding the medicines possibility, immune system disorders, other specific virus infection and specific antibody of platelet, the thrombocytopenia continuously lasted for several months. The upward trend did not begin until June 2020 and she took the tapering dose of prednisone under the instruction of the hematologist. CONCLUSION: Excluding other potentialities inducing thrombocytopenia, we highly hypothesized the SARS-CoV-2 may cause thrombocytopenia by disturbing the immune system to induce the thrombocytopenia in our report,, which needs longer time to restore the immune system and platelet count via the glucocorticoid. We firstly reported this case in order to contribute the clinician to better deal with the patients like this.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Pneumonia, Viral/complications , Thrombocytopenia/virology , COVID-19 , Female , Humans , Lymphocyte Count , Middle Aged , Pandemics , Platelet Count , RNA, Viral/analysis , SARS-CoV-2
9.
J Clin Pathol ; 74(11): 750-751, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-873566

ABSTRACT

Thrombocytopenia is common in an intensive care unit (ICU) setting due to endogenous and iatrogenic factors. Despite that, thrombocytopenia in patients with severe COVID-19 infections is surprisingly uncommon. By examining the blood film of 20 ICU patients with COVID-19, we observed the presence of platelet aggregates and macrothrombocytes indicating increased platelet activity. We compared these findings with 20 blood films of non-severe COVID-19 cases where these findings were absent. These morphology features could be consistent with severe COVID-19 infection and is further evidence of the important role that platelets play when COVID-19 manifests with thrombotic complications or respiratory failure.


Subject(s)
Blood Platelets/pathology , Blood Platelets/virology , COVID-19/complications , Thrombosis/physiopathology , Thrombosis/virology , Aged , COVID-19/blood , Critical Care , Humans , Middle Aged , Platelet Count/methods , Thrombocytopenia/blood , Thrombocytopenia/physiopathology , Thrombocytopenia/virology , Thrombosis/blood
10.
J Pediatr Hematol Oncol ; 43(6): e788-e790, 2021 08 01.
Article in English | MEDLINE | ID: covidwho-811165

ABSTRACT

The literature regarding coronavirus disease of 2019 (COVID-19) infection in pediatrics indicates that children have less severe clinical presentations and lower mortality rates. There remains limited data regarding hematologic sequelae in pediatric patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Romiplostim has shown a platelet response in pediatric patients with chronic immune thrombocytopenic purpura, and eltrombopag is proven to increase platelet counts in patients with inherited thrombocytopenia. We review SARS-CoV-2-associated thrombocytopenia and present a pediatric patient with acute on chronic thrombocytopenia in the setting of COVID-19 with subsequent platelet recovery using romiplostim.


Subject(s)
COVID-19/complications , Receptors, Fc/therapeutic use , Recombinant Fusion Proteins/therapeutic use , SARS-CoV-2/isolation & purification , Thrombocytopenia/drug therapy , Thrombopoietin/therapeutic use , COVID-19/transmission , COVID-19/virology , Child , Humans , Male , Thrombocytopenia/pathology , Thrombocytopenia/virology
11.
BMJ Case Rep ; 13(9)2020 Sep 15.
Article in English | MEDLINE | ID: covidwho-772242

ABSTRACT

The SARS-CoV-2 infection has caused a pandemic with a case rate of over 290 000 lab-confirmed cases and over 40 000 deaths in the UK. There is little evidence to inform the optimal management of a patient presenting with new or relapsed acute idiopathic thrombocytopaenic purpura with concurrent SARS-CoV-2 infection. We present a case of severe thrombocytopaenia complicated by subdural haematoma and rectal bleed associated with COVID-19. A 67-year-old man, admitted with a non-productive cough and confusion, was found to be positive for COVID-19. Ten days after admission, his platelets decreased from 146×109/L to 2×109/L. His platelets did not increase despite receiving frequent platelet transfusions. He was non-responsive to corticosteroids and intravenous immunoglobulins. Romiplostim and eltrombopag were given and after 9 weeks of treatment, his platelet count normalised. He was deemed medically fit with outpatient follow-up in a haematology clinic.


Subject(s)
Coronavirus Infections/complications , Pneumonia, Viral/complications , Thrombocytopenia/virology , Aged , COVID-19 , Humans , Male , Pandemics , Severity of Illness Index
12.
Blood Adv ; 4(13): 2967-2978, 2020 07 14.
Article in English | MEDLINE | ID: covidwho-625455

ABSTRACT

Thrombocytopenia is a common complication of influenza virus infection, and its severity predicts the clinical outcome of critically ill patients. The underlying cause(s) remain incompletely understood. In this study, in patients with an influenza A/H1N1 virus infection, viral load and platelet count correlated inversely during the acute infection phase. We confirmed this finding in a ferret model of influenza virus infection. In these animals, platelet count decreased with the degree of virus pathogenicity varying from 0% in animals infected with the influenza A/H3N2 virus, to 22% in those with the pandemic influenza A/H1N1 virus, up to 62% in animals with a highly pathogenic A/H5N1 virus infection. This thrombocytopenia is associated with virus-containing platelets that circulate in the blood. Uptake of influenza virus particles by platelets requires binding to sialoglycans and results in the removal of sialic acids by the virus neuraminidase, a trigger for hepatic clearance of platelets. We propose the clearance of influenza virus by platelets as a paradigm. These insights clarify the pathophysiology of influenza virus infection and show how severe respiratory infections, including COVID-19, may propagate thrombocytopenia and/or thromboembolic complications.


Subject(s)
Blood Platelets/virology , Influenza A virus/pathogenicity , Influenza, Human/complications , N-Acetylneuraminic Acid/metabolism , Polysaccharides/metabolism , Thrombocytopenia/etiology , Animals , Blood Platelets/metabolism , Blood Platelets/pathology , Disease Models, Animal , Ferrets , Host-Pathogen Interactions , Humans , Influenza A Virus, H1N1 Subtype/pathogenicity , Influenza A Virus, H1N1 Subtype/physiology , Influenza A Virus, H3N2 Subtype/pathogenicity , Influenza A Virus, H3N2 Subtype/physiology , Influenza A Virus, H5N1 Subtype/pathogenicity , Influenza A Virus, H5N1 Subtype/physiology , Influenza A virus/physiology , Influenza, Human/metabolism , Influenza, Human/pathology , Influenza, Human/virology , Orthomyxoviridae Infections/complications , Orthomyxoviridae Infections/metabolism , Orthomyxoviridae Infections/pathology , Orthomyxoviridae Infections/virology , Thrombocytopenia/metabolism , Thrombocytopenia/pathology , Thrombocytopenia/virology , Virus Internalization
13.
Br J Haematol ; 192(6): 973-977, 2021 03.
Article in English | MEDLINE | ID: covidwho-751791

ABSTRACT

Thrombocytopenia has been identified as a common complication of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in the general population. In an attempt to determine the impact of coronavirus disease 2019 (COVID-19) in patients with immune thrombocytopenia (ITP), a retrospective single-centre study was performed. Thrombocytosis was observed in patients with chronic ITP after SARS-CoV-2 infection, frequently needing treatment adjustment or even discontinuation of therapy. Relapses and newly diagnosed cases showed a fast response after initial treatment compared to ITP. Reduced immune activity due to lymphopenia during COVID-19 could explain this paradoxical effect, although further studies are needed.


Subject(s)
COVID-19/blood , Thrombocytopenia/virology , Adult , Aged , Aged, 80 and over , COVID-19/pathology , COVID-19/virology , Female , Humans , Male , Middle Aged , Retrospective Studies , SARS-CoV-2/isolation & purification , Thrombocytopenia/blood , Thrombocytopenia/immunology , Thrombocytopenia/pathology
15.
J Allergy Clin Immunol ; 146(5): 1194-1200.e1, 2020 11.
Article in English | MEDLINE | ID: covidwho-728636

ABSTRACT

BACKGROUND: We studied 2 unrelated patients with immune thrombocytopenia and autoimmune hemolytic anemia in the setting of acute infections. One patient developed multisystem inflammatory syndrome in children in the setting of a severe acute respiratory syndrome coronavirus 2 infection. OBJECTIVES: We sought to identify the mechanisms underlying the development of infection-driven autoimmune cytopenias. METHODS: Whole-exome sequencing was performed on both patients, and the impact of the identified variants was validated by functional assays using the patients' PBMCs. RESULTS: Each patient was found to have a unique heterozygous truncation variant in suppressor of cytokine signaling 1 (SOCS1). SOCS1 is an essential negative regulator of type I and type II IFN signaling. The patients' PBMCs showed increased levels of signal transducer and activator of transcription 1 phosphorylation and a transcriptional signature characterized by increased expression of type I and type II IFN-stimulated genes and proapoptotic genes. The enhanced IFN signature exhibited by the patients' unstimulated PBMCs parallels the hyperinflammatory state associated with multisystem inflammatory syndrome in children, suggesting the contributions of SOCS1 in regulating the inflammatory response characteristic of multisystem inflammatory syndrome in children. CONCLUSIONS: Heterozygous loss-of-function SOCS1 mutations are associated with enhanced IFN signaling and increased immune cell activation, thereby predisposing to infection-associated autoimmune cytopenias.


Subject(s)
Anemia, Hemolytic, Autoimmune/immunology , Anemia, Hemolytic, Autoimmune/virology , Coronavirus Infections/complications , Pneumonia, Viral/complications , Systemic Inflammatory Response Syndrome/immunology , Systemic Inflammatory Response Syndrome/virology , Thrombocytopenia/immunology , Thrombocytopenia/virology , Adolescent , Anemia, Hemolytic, Autoimmune/genetics , Betacoronavirus , COVID-19 , Child, Preschool , Coronavirus Infections/immunology , Haploinsufficiency , Humans , Male , Mutation , Pandemics , Pneumonia, Viral/immunology , SARS-CoV-2 , Suppressor of Cytokine Signaling 1 Protein/genetics , Thrombocytopenia/genetics
16.
J Card Surg ; 35(11): 3202-3204, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-713504

ABSTRACT

Patients with durable left ventricular assist devices pose special problems for management in the setting of COVID-19 infection. We describe the successful management of a 44-year-old man with severe COVID-19 infection and HeartMate 3 left ventricular assist device. His course was complicated by cytokine storm and COVID-19-associated coagulopathy. We describe our institutional protocol for managing COVID-19 infection in patients on mechanical circulatory support, focusing on the need for a thoughtful, multidisciplinary approach.


Subject(s)
COVID-19/complications , Heart-Assist Devices , Hematoma , Thrombosis , Adult , Anticoagulants/therapeutic use , Aspirin/therapeutic use , Biomarkers/blood , Blood Transfusion , Cytokine Release Syndrome/virology , Fibrin Fibrinogen Degradation Products/analysis , Fibrinogen/analysis , Hematoma/therapy , Hematoma/virology , Hematuria/therapy , Hematuria/virology , Hemorrhage/therapy , Hemorrhage/virology , Heparin/therapeutic use , Humans , Male , Platelet Aggregation Inhibitors/therapeutic use , Retroperitoneal Space , Thrombocytopenia/therapy , Thrombocytopenia/virology , Thrombosis/therapy , Thrombosis/virology
17.
Acta Haematol ; 144(1): 10-23, 2021.
Article in English | MEDLINE | ID: covidwho-690361

ABSTRACT

Coronavirus disease 2019 (COVID-19) is affecting millions of patients worldwide. It is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which belongs to the family Coronaviridae, with 80% genomic similarities to SARS-CoV. Lymphopenia was commonly seen in infected patients and has a correlation to disease severity. Thrombocytopenia, coagulation abnormalities, and disseminated intravascular coagulation were observed in COVID-19 patients, especially those with critical illness and non-survivors. This pandemic has caused disruption in communities and hospital services, as well as straining blood product supply, affecting chemotherapy treatment and haematopoietic stem cell transplantation schedule. In this article, we review the haematological manifestations of the disease and its implication on the management of patients with haematological disorders.


Subject(s)
Disseminated Intravascular Coagulation , Hematopoietic Stem Cell Transplantation , Lymphopenia , Pandemics , SARS-CoV-2/metabolism , Thrombocytopenia , COVID-19/blood , COVID-19/mortality , COVID-19/therapy , Disseminated Intravascular Coagulation/blood , Disseminated Intravascular Coagulation/mortality , Disseminated Intravascular Coagulation/therapy , Disseminated Intravascular Coagulation/virology , Humans , Lymphopenia/blood , Lymphopenia/mortality , Lymphopenia/therapy , Lymphopenia/virology , Thrombocytopenia/blood , Thrombocytopenia/mortality , Thrombocytopenia/therapy , Thrombocytopenia/virology
19.
Leuk Lymphoma ; 61(12): 2790-2798, 2020 12.
Article in English | MEDLINE | ID: covidwho-639286

ABSTRACT

The emergence of the Coronavirus Disease -19 (COVID-19) pandemic, has had a tremendous global impact, resulting in substantial morbidity and mortality worldwide and especially in the United States, where nearly one third of the cases are located. Although involvement of the lower respiratory track accounts for most of the morbidity and mortality seen, the virus involves several organ systems and the syndrome exhibits clinical diversity with a wide range of symptoms and manifestations. The involvement of elements of the hematopoietic system is prominent in severe cases and associated with poor outcomes and mortality. Lymphopenia, leukopenia, thrombocytopenia, disseminated intravascular coagulation, and a prothrombotic state are common manifestations of COVID-19 and have important treatment and prognostic implications. Better understanding of the mechanisms of the pathophysiology of COVID-19-induced hematological abnormalities may ultimately result in better ways to treat them and decrease the associated morbidity and mortality.


Subject(s)
COVID-19/blood , Disseminated Intravascular Coagulation/virology , Lymphopenia/virology , SARS-CoV-2/pathogenicity , Thrombocytopenia/virology , COVID-19/complications , COVID-19/diagnosis , COVID-19/epidemiology , Disseminated Intravascular Coagulation/diagnosis , Disseminated Intravascular Coagulation/mortality , Hematopoietic System/virology , Humans , Lymphopenia/diagnosis , Lymphopenia/mortality , Pandemics , Prognosis , Severity of Illness Index , Thrombocytopenia/diagnosis , Thrombocytopenia/mortality
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