Pathological effects of SARS-CoV-2 on hematological and immunological cells: Alterations in count, morphology, and function

Ahmadi, Ehsan; Bagherpour, Zahra; Zarei, Elmira; Omidkhoda, Azadeh

doi:10.1016/j.prp.2022.153782

Cited by 20 publications

(32 citation statements)

References 190 publications

(443 reference statements)

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“…Several surface markers and functional alterations have been described in blood cells of COVID-19 patients (for a review see Ahmadi et al, 2022 ). Complement activation products, such as C3b and C4d, and viral antigens have been described on RBCs surface in patients with COVID-19 ( Lam et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Red Blood Cell Morphologic Abnormalities in Patients Hospitalized for COVID-19

Marchi

Bozzini²,

Bertolone³

et al. 2022

Front. Physiol.

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Peripheral blood smear is a simple laboratory tool, which remains of invaluable help for diagnosing primary and secondary abnormalities of blood cells despite advances in automated and molecular techniques. Red blood cells (RBCs) abnormalities are known to occur in many viral infections, typically in the form of mild normo-microcytic anemia. While several hematological alterations at automated complete blood count (including neutrophilia, lymphopenia, and increased red cell distribution width—RDW) have been consistently associated with severity of COVID-19, there is scarce information on RBCs morphological abnormalities, mainly as case-reports or small series of patients, which are hardly comparable due to heterogeneity in sampling times and definition of illness severity. We report here a systematic evaluation of RBCs morphology at peripheral blood smear in COVID-19 patients within the first 72 h from hospital admission. One hundred and fifteen patients were included, with detailed collection of other clinical variables and follow-up. A certain degree of abnormalities in RBCs morphology was observed in 75 (65%) patients. Heterogenous alterations were noted, with spiculated cells being the more frequent morphology. The group with >10% RBCs abnormalities had more consistent lymphopenia and thrombocytopenia compared to those without abnormalities or <10% RBCs abnormalities (p < 0.018, and p < 0.021, respectively), thus underpinning a possible association with an overall more sustained immune-inflammatory “stress” hematopoiesis. Follow-up analysis showed a different mortality rate across groups, with the highest rate in those with more frequent RBCs morphological alterations compared to those with <10% or no abnormalities (41.9%, vs. 20.5%, vs. 12.5%, respectively, p = 0.012). Despite the inherent limitations of such simple association, our results point out towards further studies on erythropoiesis alterations in the pathophysiology of COVID-19.

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Section: Discussionmentioning

confidence: 99%

Red Blood Cell Morphologic Abnormalities in Patients Hospitalized for COVID-19

Marchi

Bozzini²,

Bertolone³

et al. 2022

Front. Physiol.

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“…Overwhelming data identify lymphopenia and thrombocytopenia as hallmarks of severe COVID‐19. 4 , 13 , 16 Besides variable total leukocyte counts, sustained lymphopenia and thrombocytopenia were observed in critically ill patients. Mechanisms leading to profound and persistent lymphopenia in sepsis include redistribution of lymphocytes and accelerated apoptosis, with selective susceptibility of Th1 T cells.…”

Section: Discussionmentioning

confidence: 99%

“…Thrombocytopenia is another common sign among COVID‐19 patients and is correlated with in‐hospital death. 3 , 4 , 5 , 6 , 15 , 27 The mechanism for thrombocytopenia in COVID‐19 is multifactorial. Megakaryocytopoiesis might be directly affected by SARS‐CoV2 or by inflammatory cytokines, while the lungs, as an important site of platelet production, suffer infection‐induced damage.…”

Section: Discussionmentioning

confidence: 99%

“…Likewise, exaggerated inflammatory response plays an integral part in the pathogenesis of severe COVID‐19. 2 , 3 , 4 , 5 , 6 , 7 , 8 …”

Section: Introductionmentioning

confidence: 99%

“… 7 , 16 , 17 , 18 These features appear to be the result of direct viral effects on lymphocytes, inefficient T cell activation and proliferation, leukocyte redistribution with pulmonary entrapment, and processes of functional exhaustion, especially of CD8+ T and NK cells. 4 , 5 , 14 , 16 , 19 …”

Section: Introductionmentioning

confidence: 99%

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Platelet‐derived immuno‐inflammatory indices show best performance in early prediction of COVID‐19 progression

Milenković

Djindjić

Djordjević

et al. 2022

Clinical Laboratory Analysis

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Background Coronavirus disease 2019 (COVID‐19) profoundly affects the immune and hematopoietic systems with various degrees of reactive changes in the blood cell counts. Immuno‐inflammatory indices are considered a simple and effective tool in the prediction of COVID‐19 outcomes. We aimed to evaluate and compare the usefulness of leukocyte and platelet counts‐based immuno‐inflammatory indices on admission to hospital in predicting COVID‐19 progression and mortality. Methods A total of 945 patients were enrolled. In addition to blood cell counts, we assessed hemogram‐derived immuno‐inflammatory indices in relation to COVID‐19 progression and death. The indices were tested by analysis of variance, receiver operating characteristic curve analysis, and binomial logistic regressions. Results Patients with severe COVID‐19 had significantly higher counts of neutrophils, eosinophils, and large immature cells (LIC), while decreased counts of platelets and monocytes. Lymphopenia was found in all of the patients, but without significant association with the outcomes. Patients with a LIC count ≥0.265 x 0 9 /L had 54.7% more odds of having COVID‐19 progression. In multivariable analyses, platelets/neutrophil‐to‐lymphocyte ratio (P/NLR) and platelets‐to‐neutrophil radio (P/N) were significant independent predictors of COVID‐19 progression and mortality. The odds of a poor outcome were two times higher in cases with P/NLR < 43 x 10 9 /L and P/N < 29 x 10 9 /L. Conclusion Indices that include platelet count in combination with neutrophil and/or lymphocyte counts displayed the best discriminatory ability and prognostic value of COVID‐19 outcomes. Additionally, LIC showed promising results in the early identification of severe COVID‐19.

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Hematological characteristics of COVID‐19 patients with fever infected by the Omicron variant in Shanghai: A retrospective cohort study in China

Wei

Cheng

et al. 2022

Clinical Laboratory Analysis

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Background A wave of the Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection has rapidly spread in Shanghai, China. Hematological abnormalities have been reported in coronavirus disease 2019 (COVID‐19) patients; however, the difference in hematological parameters between COVID‐19 patients with fever and patients who are febrile from other causes remains unexplored. Methods This retrospective cohort study enrolled 663 SARS‐CoV‐2 positive patients identified by RT‐PCR. Clinical parameters, including age, sex, and threshold cycle values of all COVID‐19 patients, and hematological parameters of COVID‐19 patients in the fever clinic were abstracted for analysis. Results Overall, 60.8% of COVID‐19 patients were male, and the median age was 45 years. Most of COVID‐19 patients were asymptomatic, while 25.8% of patients showed fever and 10.9% of patients had other emergencies. COVID‐19 patients with fever had significantly lower white blood cells (WBCs), neutrophils, lymphocytes, platelets and C‐reactive protein (CRP), and significantly higher monocyte‐to‐lymphocyte ratio (MLR), platelet‐to‐lymphocyte ratio (PLR), mean platelet volume (MPV), and mean platelet volume‐to‐platelet ratio (MPR) levels, compared with those in SARS‐CoV‐2 negative patients with fever from other causes (p < 0.05). Neutrophil‐to‐lymphocyte ratio (NLR), PLR, and systemic inflammatory index (SII) levels were significantly higher in COVID‐19 patients with emergencies (p < 0.05). WBCs showed the best performance with an area under the curve (0.756), followed by neutrophils (0.730) and lymphocytes (0.694) in the diagnosis of COVID‐19 in the fever clinic. Conclusion WBCs, neutrophils, lymphocytes, platelets, CRP and MLR, PLR, and MPR may be useful in early diagnosis of COVID‐19 in the fever clinic.

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Pathological effects of SARS-CoV-2 on hematological and immunological cells: Alterations in count, morphology, and function

Cited by 20 publications

References 190 publications

Red Blood Cell Morphologic Abnormalities in Patients Hospitalized for COVID-19

Red Blood Cell Morphologic Abnormalities in Patients Hospitalized for COVID-19

Platelet‐derived immuno‐inflammatory indices show best performance in early prediction of COVID‐19 progression

Hematological characteristics of COVID‐19 patients with fever infected by the Omicron variant in Shanghai: A retrospective cohort study in China

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