Abstract
ObjectiveSince the beginning of the coronavirus disease 2019 (COVID-19) pandemic, many studies have described the quantitative peripheral blood findings seen in COVID-19 patients. However, morphologic changes have been described by only a few studies. We report morphologic and quantitative changes in peripheral blood of COVID-19 patients.DesignWe reviewed electronic medical records, complete blood counts, and peripheral blood smears of 20 patients who were COVID-19 positive by reverse transcriptase-polymerase chain reaction (RT-PCR), from March 1, 2020, through May 31, 2020. The peripheral blood smears of all 20 patients were retrieved and morphological features of white blood cells, red blood cells, and platelets were reviewed and documented. Appropriate pictures were taken.ResultsOf the 20 patients reviewed, 13 were males and seven were females. The average age of the patients was 65.1 years. The most common quantitative hematologic abnormalities noted on complete blood count (CBC) were anemia followed by neutrophilia, neutrophilic left shift, and lymphopenia. The most significant morphologic changes noted were neutrophils with clumped chromatin, multiple abnormal nuclear shapes, pseudo-Pelger-Huet deformity, and smudged neutrophils. Lymphocytes showed abundant blue cytoplasm and/or lymphoplasmacytoid morphology and monocytes were activated with abnormal shapes and vacuolization. Platelets were adequate in number in the majority of patients and platelet clumping was the most significant finding noted. The red blood cells were normocytic and normochromic with few nucleated red blood cells and coarse basophilic stippling.ConclusionOur study identifies and describes significant morphologic changes in the peripheral blood cells of COVID-19 patients. An understanding of these morphologic changes in addition to established hematologic parameters can aid in the diagnosis of COVID-19 and serial CBC and peripheral smear review may help with management decisions in COVID-19 patients.
Highlights
Coronavirus disease 2019 (COVID-19) is caused by the new virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was first identified in Wuhan, China in December 2019 [1]
The most common quantitative hematologic abnormalities noted on complete blood count (CBC) were anemia followed by neutrophilia, neutrophilic left shift, and lymphopenia
Lymphocytes showed abundant blue cytoplasm and/or lymphoplasmacytoid morphology and monocytes were activated with abnormal shapes and vacuolization
Summary
Coronavirus disease 2019 (COVID-19) is caused by the new virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was first identified in Wuhan, China in December 2019 [1]. The pathogenesis of COVID-19 is not fully understood, studies have shown that the virus which is transmitted primarily via respiratory droplets, penetrates the host cell by interacting with the angiotensin-converting enzyme 2 (ACE2), a monocarboxypeptidase present on the surface of many cell types including epithelial cells lining the respiratory tract and capillary endothelial cells [3]. Invasion of these cells by the virus activates a series of events that leads to derangement of the renin-angiotensin-aldosterone axis with consequent deleterious effects [4]. An understanding of these morphologic changes in addition to established hematologic parameters can aid in the diagnosis of COVID-19 and serial complete blood
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