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

Abstract

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.

Alterações leucocitárias em pacientes com COVID-19 observadas em extensão de sangue periférico

“…Assim como em diversas enfermidades, o hemograma apresenta alterações significativas em pacientes com COVID-19 (Berber et al, 2020). Os parâmetros hematológicos dos pacientes vêm sendo cada vez mais abordados em diversos estudos por serem características importantes da doença.…”

“…Os linfócitos reativos semelhantes às células de Downey (Figura 3), que mimetizam morfologicamente as células observadas nos pacientes infectados pelo vírus Epstein-Barr ou infecção por citomegalovírus (Gérard, Henry & Thomas, 2020), foram observados com menos frequência (Berber et al, 2020;Chong et al, 2020;Gérard, Henry & Thomas, 2020;Jamal et al, 2020;Lee & Teo, 2020;Lüke et al, 2020;Nazarullah et al, 2020;Schapkaitz, Jager & Levy, 2020). Outras morfologias citadas com menos frequência incluem a presença ocasional de grânulos citoplasmáticos (Gérard, Henry & Thomas, 2020;Jamal et al, 2020;Kaur et al, 2021;Nazarullah et al, 2020;Schapkaitz, Jager & Levy, 2020;Singh et al, 2020; e linfócitos reativos com grandes inclusões citoplasmáticas, semelhantes às células de Mott (Foldes et al, 2020;Lee & Teo, 2020;Lüke et al, 2020).…”

“…Quanto à morfologia, foram identificadas várias células displásicas (figura 5). Os neutrófilos exibiam presença de granulações tóxicas (Berber et al, 2020;Kaur et al, 2021;Nazarullah et al, 2020;Pozdnyakova et al, 2020;Salib & Teruya-Feldsteins, 2020;Singh et al, 2020;Zini et al, 2020), vacúolos citoplasmáticos (Kaur et al, 2021;Pozdnyakova et al, 2020;Singh et al, 2020;Zini et al, 2020), núcleo hipersegmentado (Salib & Teruya-Feldsteins, 2020) e múltiplas formas anormais, como núcleo em anel, em forma de C (Kaur et al, 2021;Singh et al, 2020;Zini et al, 2020). Figura 5.…”

“…Outro achado relatado foi à presença de neutrófilos hipogranulares ou com áreas agranulares concentradas na periferia da célula (Ahnach et al, 2020;Berber et al, 2020;Pozdnyakova et al, 2020;Salib & Teruya-Feldsteins, 2020;Zini et al, 2020). Anurag, Jha & Kumar (2020), relataram que durante a pneumonia causada pelo SARS-CoV-2, como mecanismo de defesa, os neutrófilos tornam-se citotóxicos por meio da degranulação e lise, e isso podem agravar a imunopatologia da COVID-19.…”

“…(2020) (figura 6). A anomalia Perger-Huet é uma condição hereditária, mas o tipo adquirido está associado a várias patologias, como a Síndrome Mielodisplásica e abuso de drogas, mas nenhuma dessas condições foi observada nos pacientes com COVID-19 (Berber et al, 2020). Figura 6.…”