Peripheral granular lymphocytopenia and dysmorphic leukocytosis as simple prognostic markers in COVID-19

Hematological Indices in COVID-19 Patients with Rhinosinusitis Mucormycosis

Introduction

Rhinosinusitis mucormycosis (RM) is an invasive opportunistic fungal infection, especially among COVID-19 patients. The current study aimed to assess the peripheral blood hematological disorders of COVID-19 patients-associated RM.

Materials and Methods

During ten month, in two COVID-19 centers in Mashhad, Iran, from June 2021 to March 2022, eighty-three patients suspected of COVID-19 with rhinosinusitis or rhino-orbital mucormycosis participated in this study. The hematological indices of these patients were measured by independent sample T-test or Mann-Whitney test for quantitative data, and the qualitative variables were analyzed using Chi-square or Fisher's exact test in SPSS version 20 at a significance level of 0.05.

Results

Of the COVID-19 patients, 40 (48.2%) were affected by RM, and leukocytosis due to neutrophilia was observed in 30% of them. Leukocyte counts were normal in 10 (25%) patients, but 1 (2.5%) and 3 (7.5%) had leukopenia and lymphopenia, respectively. Leukocytosis plus lymphopenia was observed in 7 (17.5%) patients. Also, the synchronicity of leukopenia and lymphopenia was seen in 5 (12.5%) patients. Leukopenia, lymphopenia, and neutropenia have occurred concurrently in 2 (5%) patients. The complete blood count (CBC) showed that RBCs, hemoglobin (Hb), hematocrit (HCT), MCH, MCHC, platelet (PLT), and lymphocytes decreased while neutrophils increased.

Conclusion

Among the hematological parameters, leukocytosis due to neutrophilia and reduction in Hb, HCT, and PLT are more dominant factors in COVID-19 patients-associated RM.

A Comparative Analysis of Laboratory Parameters of Hospitalized COVID-19 Patients by Disease Severity and Mortality at a Facility in Ibadan, Nigeria

Background

COVID-19, which is caused by the SARS-CoV-2 virus, is associated with abnormalities of biochemical parameters. There are indications that some of these biochemical parameters can differ according to the severity of the disease and the outcome of the infection. This study describes and compares laboratory findings among COVID-19 patients hospitalized at a facility in Southwestern Nigeria according to disease severity and mortality.

Methodology

Records of 223 patients with COVID-19 disease admitted between March 2020 and May 2021 were retrospectively collected. Socio-demographic characteristics, laboratory parameters, and patient outcomes were obtained. Patients were classified according to COVID-19 severity. Laboratory parameters were compared between patients with severe and non-severe disease and between survivors and non-survivors.

Results

Of the 215 patients with some laboratory data included in the analysis, there were 133 (62%) males, and 56.7% were aged above 60 years. A total of 71.6% had severe COVID-19 and 48.4% died during hospitalization. The severe disease occurred significantly more frequently among non-survivors (P0.01). Higher leukocyte and neutrophil counts, urea levels, D-Dimer, and fasting blood glucose levels occurred significantly more frequently in both severe disease and mortality categories. Additionally, elevated GGT and CRP were significantly more common in those with severe than non-severe disease while lower hemoglobin, hematocrit, albumin, and higher creatinine levels were significantly more common in non-survivors.

Conclusion

Our study found that certain readily obtainable biochemical parameters occur more frequently with severe disease and/or mortality amongst patients hospitalized with COVID-19 in sub-Saharan Africa and might be useful for prognostication and allocation of resources.

Prospects for the Use of Marine Sulfated Fucose-Rich Polysaccharides in Treatment and Prevention of COVID-19 and Post-COVID-19 Syndrome

Symptoms of the new coronavirus infection that appeared in 2019 (COVID-19) range from low fever and fatigue to acute pneumonia and multiple organ failure. The clinical picture of COVID-19 is heterogeneous and involves most physiological systems; therefore, drugs with a wide spectrum of mechanism of action are required. The choice of the treatment strategy for post-COVID-19 syndrome is still a challenge to be resolved. Polysaccharides with a high fucose content derived from seaweed and marine animals can form the basis for the subsequent development of promising agents for the treatment of COVID-19 and post-COVID-19 syndrome. This class of biopolymers is characterized by a variety of biological activities, including antiviral, antithrombotic, anticoagulant, hemo-stimulating, anti-inflammatory and immune-regulatory. Low molecular weight derivatives of these polysaccharides, as well as synthetic oligosaccharides with a sufficient amount and sulfation type may be considered as the most promising compounds due to their better bioavailability, which undoubtedly increases their therapeutic potential.

Coronavirus disease 2019 (COVID-19): Focus on peripheral blood cell morphology

Numerous studies have shown peculiar morphological anomalies in COVID-19 patients' smears. We searched all the peer-reviewed scientific publications that explicitly reference the cytomorphological alterations on peripheral blood smears of patients with COVID-19. We extracted data from sixty-five publications (case reports, patient group studies, reviews, and erythrocyte morphology studies). The results show that frequent alterations concern the morphology of lymphocytes (large lymphocytes with weakly basophilic cytoplasm, plasmacytoid lymphocytes, large granular lymphocytes). Neutrophils display abnormal nuclei and cytoplasm in a distinctive cytomorphological picture. Besides a left shift in maturation, granulations can be increased (toxic type) or decreased with areas of basophilia. Nuclei are often hyposegmented (pseudo-Pelger-Huёt anomaly). Apoptotic or pycnotic cells are not uncommon. Monocytes typically have a large cytoplasm loaded with heterogeneous and coalescing vacuoles. Platelets show large and giant shapes. The presence of erythrocyte fragments and schistocytes is especially evident in the forms of COVID-19 that are associated with thrombotic microangiopathies. Such atypia of blood cells reflects the generalized activation in severe COVID-19, which has been demonstrated with immunophenotypic, molecular, genetic, and functional methods. Neutrophils, in particular, are involved in the pathophysiology of hyperinflammation with cytokine storm, which characterizes the most unfavorable evolution.

Emergency Hematopoiesis in the Pathobiology of COVID-19: The Dark Side of an Early Innate Protective Mechanism

The recognition of pathogens to which we are constantly exposed induces the immediate replenishment of innate immune cells from the most primitive stages of their development through emergency hematopoiesis, a central mechanism contributing to early infection control. However, as with other protective mechanisms, its functional success is at risk when the excess of inducing signals accelerates immunological catastrophes. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection exhibits a clinical spectrum that ranges from completely asymptomatic states to fatal outcomes, with the amplification of inflammatory components being the critical point that determine the progress, complication, and severity of the disease. This review focuses on the most relevant findings that entail emergency hematopoiesis to SARS-CoV-2 infection response and revolutionize our understanding of the mechanisms governing the clinical prognosis of COVID-19. Of special interest are the metabolic or hyperinflammatory conditions in aging that exacerbate the phenomenon and favor the uncontrolled emergency myelopoiesis leading to the evolution of severe disease.