Clinical significance of blue‐green neutrophil and monocyte cytoplasmic inclusions in SARS‐CoV‐2 positive critically ill patients

Cantu, Miguel Dario; Towne, William S; Emmons, Foxwell; Mostyka, Maria; Salvatore, Steven; Yang, He; Zhao, Zhen; Vasovic, Ljiljana V.; Racine‐Brzostek, Sabrina

doi:10.1111/bjh.16882

Cited by 32 publications

(47 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…They showed that blue-green inclusions might correlate with short-term mortality. 24 Similar inclusions were found by us in one patient’s lymphocytes with a severe stage ( Figure 1H ), showing that they are not specific for myeloid lineage. Alterations of granulocytes can be different in COVID-19; Christian Salib et al showed hypersegmented granulocytes infected patients; 25 in our study, we found that pseudo-Pelger-Huet anomalies were significantly present, especially in severe patients.…”

Section: Discussionsupporting

confidence: 77%

Simple Peripheral Blood Smear Findings of Covid-19 Patients Provide Information About the Severity of the Disease and the Duration of Hospital Stay.

Berber

Çağaşar

Sarıcı

et al. 2020

Mediterr J Hematol Infect Dis

View full text Add to dashboard Cite

Backround Data about the morphological changes of Covid-19 infection in peripheral blood smear are limited and association with clinical severity of the disease are not known yet. We aimed to examine the characteristics of the cells detected in the pathological rate and / or appearance and whether these findings are related to the clinical course by evaluating the peripheral blood smear at the time of diagnosis in Covid-19 patients. Methods Clinical features, laboratory data, peripheral blood smear of fifty patients diagnosed with Covid-19 by PCR was evaluated at diagnosis. Peripheral smear samples of the patients were compared with the age and sex matched 30 healthy controls. Pictures were taken from the paitients’peripheral blood smear. Patients were divided into two groups. Early and advanced stage patient groups were compared in terms of laboratory data and peripheral smear findings. The relationship between the laboratory values of all patients and the duration of hospitalization was analyzed. Results Pseudo pelger-huet, atypical lymphocytes, vacuole monocytes and pycnotic neutrophils rates were high in the patient group. Increased pseudo pelger-huet anomaly, psodo-pelger huet/mature lymphocyte ratio, decreased number of mature lymphocytes, and eosinophils in peripheral blood smear were observed in the advanced stage patients (p <0.05). A negative correlation was observed between the duration of hospitalization and mature lymphocyte, and monocytes with vacuoles rates (p <0.05). Conclusion Peripheral smear is a cheap, easily performed, and rapid test. Increased pseudo-pelger huet anomaly/mature lymphocytes rate is suggesting advanced stage disease, while high initial monocytes with vacuoles and mature lymphocyte rates at the time of diagnosis may be an indicator of shortened duration of hospitalization.

show abstract

Section: Discussionsupporting

confidence: 77%

Simple Peripheral Blood Smear Findings of Covid-19 Patients Provide Information About the Severity of the Disease and the Duration of Hospital Stay.

Berber

Çağaşar

Sarıcı

et al. 2020

Mediterr J Hematol Infect Dis

View full text Add to dashboard Cite

show abstract

“…While immunohistochemical staining failed to prove their identity as macrophage, megakaryocytic, or endothelial derived structures, there is a possibility that IHC staining was compromised on this autolyzed autopsy material. As one of these patients had blue-green crystals in circulating monocytes and neutrophils premortem, which have been ascribed to liver injury in the literature, it is possible that these structures are related [ 37 ]. By further identification and study of these structures, hopefully full characterization will be possible.…”

Section: Discussionmentioning

confidence: 99%

Autopsy Findings in 32 Patients with COVID-19: A Single-Institution Experience

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background A novel coronavirus, SARS-CoV-2, was identified in Wuhan, China in late 2019. This virus rapidly spread around the world causing disease ranging from minimal symptoms to severe pneumonia, which was termed coronavirus disease (i.e., COVID). Postmortem examination is a valuable tool for studying the pathobiology of this new infection. Methods We report the clinicopathologic findings from 32 autopsy studies conducted on patients who died of COVID-19 including routine gross and microscopic examination with applicable special and immunohistochemical staining techniques. Results SARS-CoV-2 infection was confirmed by nasopharyngeal RT-PCR in 31 cases (97%) and by immunohistochemical staining for SARS-CoV-2 spike-protein in the lung in the remaining 1 case (3%). The ethnically diverse cohort consisted of 22 males and 10 females with a mean age of 68 years (range: 30–100). Patients most commonly presented with cough (17 [55%]), shortness of breath (26 [81%]), and a low-grade fever (17 [55%]). Thirty-one (97%) of the patients had at least 1 comorbidity (mean = 4). Twenty-eight patients (88%) had widespread thromboembolic disease, as well as diffuse alveolar damage (30 [94%]), diabetic nephropathy (17 [57%]) and acute tubular injury. Patterns of liver injury were heterogeneous, featuring 10 (36%) with frequent large basophilic structures in sinusoidal endothelium, and increased immunoblast-like cells in lymph nodes. Conclusion This series of autopsies from patients with COVID-19 confirms the observation that the majority of severely affected patients have significant pulmonary pathology. However, many patients also have widespread microscopic thromboses, as well as characteristic findings in the liver and lymph nodes.

show abstract

“… hypergranular cytoplasm (dark, crowded, “toxic” type) 49,64 presence of small basophilic, agranular cytoplasmic areas 49 hypogranular cytoplasm 49,65 blue‐green cytoplasmic inclusions in six patients who all died, in neutrophils and monocytes, probably derived from lipid‐rich lipofuscin from necrotic liver cells 64 nuclear hyposegmentation, sometimes with apoptotic chromatin, 1 or C‐shaped, fetus‐like or ring‐shaped nuclei or nuclear detachment 61 absence of nuclear segmentation (pseudo Pelger‐Huet nuclei), with liquefied chromatin 49 apoptotic neutrophils in the circulation 1,48,49 ; disintegrated or smudged neutrophils 57 Myeloid left shift and immature granulocytes in peripheral blood in the form of increased proportion of band cells, 49 metamyelocytes, myelocytes and promyelocytes or even blast with cytoplasmic granules 49,57,62 …”

Section: Discussionmentioning

confidence: 99%

The hematology laboratory’s response to the COVID‐19 pandemic: A scoping review

Bell

Zini

D’Onofrio

et al. 2020

Int J Lab Hematology

View full text Add to dashboard Cite

The ongoing COVID‐19 pandemic has had a profound worldwide impact on the laboratory hematology community. Nevertheless, the pace of COVID‐19 hematology‐related research has continued to accelerate and has established the role of laboratory hematology data for many purposes including disease prognosis and outcome. The purpose of this scoping review was to assess the current state of COVID‐19 laboratory hematology research. A comprehensive search of the literature published between December 1, 2019, and July 3, 2020, was performed, and we analyzed the sources, publication dates, study types, and topics of the retrieved studies. Overall, 402 studies were included in this scoping review. Approximately half of these studies (n = 202, 50.37%) originated in China. Retrospective cohort studies comprised the largest study type (n = 176, 43.89%). Prognosis/ risk factors, epidemiology, and coagulation were the most common topics. The number of studies published per day has increased through the end of May. The studies were heavily biased in favor of papers originating in China and on retrospective clinical studies with limited use of and reporting of laboratory data. Despite the major improvements in our understanding of the role of coagulation, automated hematology, and cell morphology in COVID‐19, there are gaps in the literature, including biosafety and the laboratory role in screening and prevention of COVID‐19. There is a gap in the publication of papers focused on guidelines for the laboratory. Our findings suggest that, despite the large number of publications related to laboratory data and their use in COVID‐19 disease, many areas remain unexplored or under‐reported.

show abstract

Clinical significance of blue‐green neutrophil and monocyte cytoplasmic inclusions in SARS‐CoV‐2 positive critically ill patients

Cited by 32 publications

References 13 publications

Simple Peripheral Blood Smear Findings of Covid-19 Patients Provide Information About the Severity of the Disease and the Duration of Hospital Stay.

Simple Peripheral Blood Smear Findings of Covid-19 Patients Provide Information About the Severity of the Disease and the Duration of Hospital Stay.

Autopsy Findings in 32 Patients with COVID-19: A Single-Institution Experience

The hematology laboratory’s response to the COVID‐19 pandemic: A scoping review

Contact Info

Product

Resources

About