Peripheral Blood Examination Findings in SARS-CoV-2 Infection

Nazarullah, Alia; Liang, Christine; Villarreal, Andrew; Higgins, Russell A.; Mais, Daniel D.

doi:10.1093/ajcp/aqaa108

Cited by 51 publications

(96 citation statements)

References 25 publications

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“…However, we noticed another nuclear change in neutrophils in the form of Howell-Jolly body-like inclusions that was seen in 10% of patients with COVID-19. Similar to our findings, Nazarullah et al 6 have reported the presence of neutrophil toxic granulation and myeloid left shift, as well as the increased frequency of plasmacytoid lymphocytes in COVID-19–positive patients.…”

Section: Discussionsupporting

confidence: 92%

“…Interestingly, despite a clearly significant role that monocytes/macrophages play in sustaining a hyperinflammatory response in SARS-CoV-2 infection, it appears that not all patients with COVID-19 display monocyte morphologic changes in peripheral blood that we describe in our study. Nazarullah et al 6 have reported quantitative and qualitative peripheral blood changes in 12 COVID-19–positive patients and found that in their cohort, the most significant morphologic changes were related to nuclear morphology in neutrophils showing acquired Pelger-Huët anomaly and monolobate neutrophils. While we did find similar nuclear changes, they were present in a small number of neutrophils (predominantly <5% of neutrophils) and were not specific to COVID-19–positive patients; similar findings were present in COVID-19–negative ICU patients.…”

Section: Discussionmentioning

confidence: 95%

“…While there are an increasing number of publications and preprints in peer-reviewed and non-peer-reviewed journals regarding COVID-19 pathogenesis, clinical presentation, and treatment, the studies that have addressed the morphologic changes in peripheral blood associated with SARS-CoV-2 are all limited to case and image reports. 2-5 The most recent study by Nazarullah et al 6 that includes a detailed quantitative and qualitative analysis of peripheral blood changes was conducted on 12 COVID-19–positive patients. In addition, very few studies provide correlation between peripheral blood WBC morphologic changes and disease outcomes and address the dynamics of CBC parameters and morphology.…”

mentioning

confidence: 99%

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Clinical Significance of CBC and WBC Morphology in the Diagnosis and Clinical Course of COVID-19 Infection

Pozdnyakova

Connell

Battinelli

et al. 2020

American Journal of Clinical Pathology

116

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Objectives To investigate the clinical significance of numeric and morphologic peripheral blood (PB) changes in coronavirus disease 2019 (COVID-19)–positive patients in predicting the outcome, as well as to compare these changes between critically ill COVID-19–positive and COVID-19–negative patients. Methods The study included 90 COVID-19–positive (51 intensive care unit [ICU] and 39 non-ICU) patients and 30 COVID-19–negative ICU patients. We collected CBC parameters (both standard and research) and PB morphologic findings, which were independently scored by two hematopathologists. Results All patients with COVID-19 demonstrated striking numeric and morphologic WBC changes, which were different between mild and severe disease states. More severe disease was associated with significant neutrophilia and lymphopenia, which was intensified in critically ill patients. Abnormal WBC morphology, most pronounced in monocytes and lymphocytes, was associated with more mild disease; the changes were lost with disease progression. Between COVID-19–positive and COVID-19–negative ICU patients, significant differences in morphology-associated research parameters were indicative of changes due to the severe acute respiratory syndrome coronavirus 2 virus, including higher RNA content in monocytes, lower RNA content in lymphocytes, and smaller hypogranular neutrophils. Conclusions Hospitalized patients with COVID-19 should undergo a comprehensive daily CBC with manual WBC differential to monitor for numerical and morphologic changes predictive of poor outcome and signs of disease progression.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 95%

mentioning

confidence: 99%

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Clinical Significance of CBC and WBC Morphology in the Diagnosis and Clinical Course of COVID-19 Infection

Pozdnyakova

Connell

Battinelli

et al. 2020

American Journal of Clinical Pathology

116

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“…They showed that the pseudo-Pelger-Huet anomaly was recorded in all cases of COVID-19, affecting more than 5% of granulocytes in most cases. 21 Yunus Murat Akcabelen et al reported dysplastic changes in peripheral blood cells of COVID-19 patients. We also observed atypical lymphocytes, pseudo-Pelger-Huet anomaly, and dysplastic changes in peripheral blood cells in a previous study.…”

Section: Discussionmentioning

confidence: 99%

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

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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.

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“…Similar to SARS-CoV and MERS-CoV, older age is a risk factor for severe SARS-CoV-2. Whereas absolute lymphopenia is not specific to COVID-19, low CD3+, CD4+, and CD8+ T cell counts in peripheral blood have been observed in severe cases of COVID-19[39]. These cases also -21 -present with comorbidities such as chronic underlying diseases.…”

mentioning

confidence: 99%

The peripheral T cell population is associated with pneumonia severity in cynomolgus monkeys experimentally infected with severe acute respiratory syndrome coronavirus 2

Nagata

Iwata‐Yoshikawa

Sano

et al. 2021

Preprint

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The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a global pandemic that began in December 2019. Lymphopenia is a common feature in severe cases of COVID-19; however, the role of T cell responses during infection is unclear. Here, we inoculated six cynomolgus monkeys, divided into two groups according to the CD3+ T cell population in peripheral blood, with two clinical isolates of SARS-CoV-2: one of East Asian lineage and one of European lineage. After initial infection with the isolate of East Asian lineage, all three monkeys in the CD3+ low group showed clinical symptoms, including loss of appetite, lethargy, and transient severe anemia with/without short-term fever, within 14 days post-infection (p.i.). By contrast, all three monkeys in the CD3+ high group showed mild clinical symptoms such as mild fever and loss of appetite within 4 days p.i. and then recovered. After a second inoculation with the isolate of European lineage, three of four animals in both groups showed mild clinical symptoms but recovered quickly. Hematological, immunological, and serological tests suggested that the CD3+ high and low groups mounted different immune responses during the initial and second infection stages. In both groups, anti-viral and innate immune responses were activated during the early phase of infection and re-infection. However, in the CD3+ low group, inflammatory responses, such as increased production of monocytes and neutrophils, were stronger than those in the CD3+ high group, leading to more severe immunopathology and failure to eliminate the virus. Taken together, the data suggest that the peripheral T lymphocyte population is associated with pneumonia severity in cynomolgus monkeys experimentally infected with SARS-CoV-2.Author summarySARS-CoV-2 infection causes an illness with clinical manifestations that vary from asymptomatic or mild to severe; examples include severe pneumonia and acute respiratory distress syndrome. Lymphopenia, which is common in severe COVID-19 cases, is characterized by markedly reduced numbers of CD4+ T cells, CD8+ T cells, B cells, and natural killer cells. Here, we showed that cynomolgus monkeys selected according to the T cell populations in peripheral blood have different outcomes after experimental infection with SARS-CoV-2. These findings will increase our understanding of disease pathogenesis and may facilitate the development of animal models for vaccine evaluation.

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Peripheral Blood Examination Findings in SARS-CoV-2 Infection

Cited by 51 publications

References 25 publications

Clinical Significance of CBC and WBC Morphology in the Diagnosis and Clinical Course of COVID-19 Infection

Clinical Significance of CBC and WBC Morphology in the Diagnosis and Clinical Course of COVID-19 Infection

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

The peripheral T cell population is associated with pneumonia severity in cynomolgus monkeys experimentally infected with severe acute respiratory syndrome coronavirus 2

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