Hematological findings and complications of COVID‐19

Abstract

COVID-19 is a systemic infection with a significant impact on the hematopoietic system and hemostasis. Lymphopenia may be considered as a cardinal laboratory finding, with prognostic potential. Neutrophil/lymphocyte ratio and peak platelet/lymphocyte ratio may also have prognostic value in determining severe cases. During the disease course, longitudinal evaluation of lymphocyte count dynamics and inflammatory indices, including LDH, CRP and IL-6 may help to identify cases with dismal prognosis and prompt intervention in order to improve outcomes. Biomarkers, such high serum procalcitonin and ferritin have also emerged as poor prognostic factors. Furthermore, blood hypercoagulability is common among hospitalized COVID-19 patients. Elevated D-Dimer levels are consistently reported, whereas their gradual increase during disease course is particularly associated with disease worsening. Other coagulation abnormalities such as PT and aPTT prolongation, fibrin degradation products increase, with severe thrombocytopenia lead to life-threatening disseminated intravascular coagulation (DIC), which necessitates continuous vigilance and prompt intervention. So, COVID-19 infected patients, whether hospitalized or ambulatory, are at high risk for venous thromboembolism, and an early and prolonged pharmacological thromboprophylaxis with low molecular weight heparin is highly recommended. Last but not least, the need for assuring blood donations during the pandemic is also highlighted.

American College of Rheumatology Guidance for the Management of Rheumatic Disease in Adult Patients During the COVID‐19 Pandemic: Version 1

“…In addition to older age and comorbidity, a number of laboratory measures have been preliminarily associated with poor outcomes from COVID-19 (11,12). Examined in retrospective cohorts of hospitalized patients, biomarkers predictive of poor outcomes have included lymphopenia (particularly, low CD4+ T cell numbers) and elevations in circulating levels of lactate dehydrogenase, C-reactive protein, IL-6, and d-dimer, among others (19)(20)(21)(22). Whether lymphopenia portends "preexisting" risk or is a conse-quence of more severe infection in hospitalized patients is unclear.…”

The first case of acquired hemophilia A associated with SARS‐CoV‐2 infection

“…This finding is particularly interesting considering the close interaction between SARS-Cov-2 and the hemostatic system. 4 The AHA cases associated with other viral infections, including hepatitis B and C viruses, have also been described. 3 The recent association between immune thrombocytopenic purpura and COVID-19 further strengthens the virus-induced immune dysregulation, 5 which could have played a key role in the pathogenesis of AHA.…”

Nomogram for Prediction of fatal outcome in Patients with Severe COVID-19: A Multicenter Study

“…The elderly patients with severe COVID-19were more likely to develop fatal outcomes because of rapidly progression of the disease, which reminded us of providing early intervention for elderly severe patients. Similarly, lymphopenia was more common in the non-survivors and severe cases according to the previous reports, suggesting dysregulation of immune response in patients with COVID-19 [22][23][24]. Nevertheless, most of these were only descriptive studies.…”