2022, Number 2
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MEDICC Review 2022; 24 (2)
Hematological Alterations in Patients Recovered from SARS-CoV-2 Infection in Havana, Cuba
Pereira-Roche N, Roblejo-Balbuena H, Marín-Padrón LC, Sotomayor-Lugo F, González-Torres MÁ, Pérez-Rodríguez J, Álvarez-Gavilán Y, Torres-Rives B, Bravo-Ramírez M, Benítez-Codero Y, Monzón-Benítez G, Silva-Ayçaguer LC, Marcheco-Teruel B
Language: English
References: 46
Page: 7-14
PDF size: 243.98 Kb.
ABSTRACT
INTRODUCTION COVID-19 sequelae, or the short-, medium-, and long-term manifestations of the disease are under continuous study. There are currently few reports on the evolution of hematological variables following a demonstrated absence of SARS-CoV-2 after infection.
OBJECTIVE Identify hematological alterations in Cuban adults recovered from SARS-CoV-2 infection, and their relation with disease severity.
METHODS We selected 348 persons recovered from COVID-19 residing in Havana, Cuba with an RT-PCR study negative for SARS-CoV-2 performed two weeks after hospital discharge; a structured survey was administered to obtain clinical–epidemiological data. Three groups were established according to COVID-19 clinical criteria: asymptomatic, mild/moderately symptomatic, and severely symptomatic, which, in turn, were divided according to hospital discharge date and blood sample collection date. We performed hemograms with differential leukocyte counts and compared results among groups. We then measured the associations between hematological variables, personal medical history, and relevant lifestyle habits (smoking).
RESULTS All hematological variables were within normal reference limits, although men from the group of severely ill patients had increased total leukocytes, neutr
ophils and lymphocytes, and decreased hemoglobin and eosinophils, which was also evident in those with a recovery time of 31–90 days.
CONCLUSIONS The relation between hematological variables and degree of clinical severity offers evidence as to persistence of systemic alterations (possibly inflammatory) associated with viral infection. Their identification and characterization can facilitate personalized patient followup and rehabilitation.
REFERENCES
Tang D, Comish P, Kang R. The hallmarksof COVID-19 disease. PLoS Pathogen. 2020;16(5):e1008536. https:// doi.org/10.1371/journal.ppat.1008536
World Health Organization [Internet]. Novel Coronavirus(2019-nCoV) Situation Report – 22; 2020Feb 11 [cited 2020 Feb 20]. Available at: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200211-sitrep-22-ncov.pdf
Gandhi RT, Lynch JB, del Rio C. Mild to moderateCovid-19. N Engl J Med. 2020;383:1757‒66.https://doi.org/ 10.1056/NEJMcp2009249
Xu J, Ma XP, Bai L, Wang M, Deng W, Ning N. Asystematic review of etiology, epidemiology, clinicalmanifestations, image fi ndings, and medicationof 2019 Corona Virus Disease-19 in Wuhan,China. Medicine [Internet]. 2020 [cited 2020 Dec18];99:42(e22688). Available at: http://dx.doi.org/10.1097/MD.0000000000022688
Dhama K, Khan S, Tiwari R, Sircar S, Bhat S,Malik YS, et al. Coronavirus Disease 2019–COVID-19. Clin Microbiol Rev [Internet]. 2020[cited 2020 Oct 28];33(4):e00028-20. Availableat: https://journals.asm.org/doi/full/10.1128/CMR.00028-20
Berlin DA, Gulik RM, Martínez FJ. Severe Covid-19. N Engl J Med. 2020 ;383:2451‒60. https://doi.org/10.1056/NEJMcp2009575
Fan BE, Chong VCL, Chan SSW, Lim GH, LimKGE, Tan GB, et al. Hematologic parameters inpatients with COVID-19 infection. Am J Hematol.2020;95(6):E131-E134. https://doi.org/10.1002/ajh.25774
Lippi G, Plebani M. Laboratory abnormalitiesin patients with COVID-2019 infection. ClinChem Lab Med. 2020;58(7):1131–4. https://doi.org/10.1515/cclm-2020-0198
Yun H, Sun Z, Wu J, Tang A, Hu M, Xiang Z.Laboratory data analysis of novel coronavirus(COVID-19) screening in 2510 patients. Clin ChimicaActa. 2020;507:94–7. https://doi.org/10.1016/j.cca.2020.04.018
Lu G, Wang J. Dynamic changes in routine bloodparameters of a severe COVID-19 case. ClinicaChimica Acta. 2020;508:98–102. https://doi.org/10.1016/j.cca.2020.04.034
Chen J, Pan Y, Li G, Xu W, Zhang L, Yuan S, etal. Distinguishing between COVID–19 and infl uenzaduring the early stages by measurement ofperipheral blood parameters. J Med Virol [Internet].2020 [cited 2020 Dec 18];1–9. Available at:https://doi.org/10.1002/jmv.26384
Liao D, Zhou F , Luo L, Xu M, Wang H, XiaJ, et al. Haematological characteristicsand risk factors in the classification andprognosis evaluation of COVID-19: a retrospectivecohort study. Lancet Haematology.2020;7(9):e671–e678. https://doi.org/10.1016/S2352-3026(20)30217-9
Yan B, Yang J, Xie Y, Tang X. Relationship betweenblood eosinophil levels and COVID-19 mortality.World Allergy Organ J. [Internet]. 2021 [cited 2021May 12];14(3):100521. http://doi.org/10.1016/j.waojou.2021.100521
Stone JR, Tran KM, Conklin J, Mino-KenudsonM. Case record of the Massachusetts GeneralHospital. Case 23-2020: a 76-year-old womanwho died from Covid-19. N Engl J Med [Internet].2020 [cited 2020 Oct 28];383:380−7. Available at:https://www.nejm.org/doi/full/10.1056/NEJMcpc2004974
Terpos E, Ntanasis-Stathopoulos I, ElalamyI, Kastritis E, Sergentanis TN, Politou M, etal. Hematological fi ndings and complicationsof COVID-19. Am J Hematol [Internet]. 2020[cited 2020 Oct 28];95(7):834−47. https://doi.org/10.1002/ajh.25829
Liu J, Liu Y, Xiang P, Pu L, Xiong H, Li C,et al. Neutrophil to lymphocyte ratio predictscritical illness patients with 2019 coronavirusdisease in the early stage. J TranslMed. 2020;18:206. https://doi.org/10.1186/s12967-020-02374-0
Lagunas-Rangel FA. Neutrophil–o–lymphocyteratio and lymphocyte-to-C-reactive protein ratioin patients with severe coronavirus disease2019 (COVID–19): A meta-analysis. J MedVirol. 2020;92:1733–4. https://doi.org/ 10.1002/jmv.25819
Rodrigo-Muñoz JM, Sastre B, Cañas JA, Gil-Martínez M, Redondo N, del Pozo V. Eosinophilresponse against classical and emergingrespiratory viruses: COVID-19. J InvestigAllergol Clin Immunol. 2021;31(2). https://doi.org/10.18176/jiaci.0624
Mateos González M, Sierra Gonzalo E, CasadoLopez I, Arnalich Fernández F, Beato Pérez JL,Monge Monge D, et al. The Prognostic Valueof Eosinophil Recovery in COVID-19: Multicentre,retrospective cohort study on patientshospitalised in Spanish hospitals. J. Clin.Med. 2021;10(2):305. https://doi.org/10.3390/jcm10020305
Xie G, Ding F, Han L, Yin D, Lu H, Zhang M.The role of peripheral blood eosinophil countsin COVID-19 Patients. Allergy. 2020;10:1–12.https://doi.org/10.1111/all.14465
Fraisse M, Logre E, Mentec H, Cally R, PlantefeveG, Contou D. Eosinophilia in critically illCOVID-19 patients: a French monocenter retrospectivestudy. Crit Care. 2020;24:635. https://doi.org/10.1186/s13054-020-03361-z
Ministry of Public Health (CU). Protocolo de actuaciónnacional para la COVID-19. Versión 1.5 [Internet].Havana: Ministry of Public Health (CU); 2020 Aug.[cited 2020 Aug 31]. Available at: https://covid19cubadata.github.io/protocolos/protocolo-version-5.pdf. Spanish
COVID-19 Cuba Data [Internet]. Havana: Cuba-Data; c2020 [updated 2021 Sep 10; cited 2020Jun 15] [revised 2020 Jun 15]. Available at:https://covid19cubadata.github.io/#cuba. Spanish
Escobar Carmona E. Valores de referencia delLaboratorio Clínico más empleados en Cuba.Año 2011. Gaceta Médica Espirituana [Internet][cited 2020 Aug 31]; 2011;13(2). Available at:http://revgmespirituana.sld.cu/index.php/gme/article/view/257. Spanish
Mindray Bio-Medical Electronics Co [Internet].Madrid: Mindray; c2020. Productos. Diagnósticoin vitro. Analizadores hematológicos y reactivos.5-Diff Hematología. BC-6800 analizadorautomático para hematología; [cited 2020 Oct 26]; [about 3 p.]. Available at: https://www.mindray.com/es/product/BC-6800.html. Spanish.
Center for State Control of Medicines, Equipmentand Medical Devices (CU). Havana:Center for State Control of Medicines, Equipmentand Medical Devices (CU).; c2022. Cuba.Regulación no.3-2009. Buenas Prácticas deLaboratorio Clínico; 2009 [cited 2015 Oct 14].Available at: HYPERLINK "http://www.cecmed.cu/sites/default/fi les/adjuntos/Reglamentacion/Reg_03-09.pdf"http://www.cecmed.cu/sites/default/files/adjuntos/Reglamentacion/Reg_03-09.pdf#overlay-context=reglamentacion/aprobadas%3Fpage%3D8. Spanish.
Liu L, Shan H, Lei C, Hui DSC, Du B, Li L, etal. Clinical characteristics of coronavirus disease2019 in China. N Engl J Med [Internet].2020 [cited 2020 Oct 28];382:1708−20. Availableat: https://www.nejm.org/doi/full/10.1056/neJMoa2002032
Dubey AK, Singh A, Prakash S, Kumar M, SinghAK. Race to arsenal COVID-19 therapeutics:Current alarming status and future directions.Chem Biol Interact. 2020;332:109298. https://doi.org/10.1016/j.cbi.2020.109298
World Health Organization [Internet]. Geneva:World Health Organization; c2022. Publications.Overview. Living guidance for clinical managementof COVID-19; 2021 Nov 23 [cited 2021 Dec 10].Available at: https://www.who.int/publications/i/item/WHO-2019-nCoV-clinical-2021-2
Poland GA, Ovsyannikova IG, Kennedy RB.SARS-CoV-2 immunity: review and applicationsto phase 3 vaccine candidates. Lancet.2020;4:396(10262):1595−606. https://doi.org/10.1016/S0140-6736(20)32137-1
Rodriguez L, Pekkarinen PT, Lakshmikanth T,Tan Z, Consiglio CR, Pou C, et al. Systems-level immunomonitoring from acute to recoveryphase of severe COVID-19. Cell Rep Med.2020;1(5):100078. https://doi.org/10.1016/j.xcrm.2020.100078.
Wang C, Deng R, Gou L, Fu Z, Zhang X, ShaoF, et al. Preliminary study to identify severefrom moderate cases of COVID-19 using combinedhematology parameters. Ann Transl Med.2020 [cited 2020 Oct 28];8(9):593. https://doi.org/10.21037/atm-20-3391
Zhao G, Su Y, Sun X, Cui X, Dang L, Zhao L,et al. A comparative study of the laboratoryfeatures of COVID-19 and other viral pneumoniasin the recovery stage. J Clin Lab Anal.2020;34(10):e23483. https://doi.org/10.1002/jcla.23483
Sherina N, Piralla A, Du L, Wan H, Kumagai-Braesch M, Andréll J, et al. Persistence ofSARS-CoV-2-specifi c B and T cell responsesin convalescent COVID-19 patients 6-8 monthsafter the infection. Med (NY). 2021;2(3):281−95.https://doi.org/10.1016/j.medj.2021.02.001
Liang J, Nong S, Jiang L, Chi X, Bi D, Cao J,et al. Correlations of disease severity and agewith hematology parameter variations in patientswith COVID-19 pre- and post-treatment. JClin Lab Anal. 2021;35(1):e23609. https://doi.org/10.1002/jcla.23609
Shaw B, Daskareh M, Gholamrezanezhad A. Thelingering manifestations of COVID-19 during andafter convalescence: update on long-term pulmonaryconsequences of coronavirus disease 2019(COVID-19). Radiol Med. 2021;126(1):40−6.https://doi.org/10.1007/s11547-020-01295-8
Sonnweber T, Sahanic S, Pizzini A, Luger A,Schwabl C, Sonnweber B, et al. Cardiopulmonaryrecovery after COVID-19: an observationalprospective multicentre trial. EurRespir J. 2021;57(4):2003481. https://doi.org/10.1183/13993003.03481-2020
Frenkel A, Kachko E, Cohen K, Novack V,Maimon N. Estimations of a degree of steroidinduced leukocytosis in patients with acute infections.Am J Emerg Med. 2018 ;36(5):749−53.https://doi.org/10.1016/j.ajem.2017.10.003
Shoenfeld Y, Gurewich Y, Gallant LA, PinkhasJ. Prednisone-induced leukocytosis. Infl uenceof dosage, method and duration of administrationon the degree of leukocytosis. Am J Med.1981;71(5):773−8. https://doi.org/10.1016/0002-9343(81)90363-6
Taneri PE, Gómez-Ochoa SA, Llanaj E,Raguindin PF, Rojas LZ, Roa-Díaz ZM, et al.Anemia and iron metabolism in COVID-19: a systematicreview and meta-analysis. Eur J Epidemiol.2020;35(8):763−73. https://doi.org/10.1007/s10654-020-00678-5
Cavezzi A, Troiani E, Corrao S. COVID-19: hemoglobin,iron, and hypoxia beyond infl ammation. Anarrative review. Clin Pract. 2020;10(2):1271.https://doi:10.4081/cp.2020.1271
Tao Z, Xu J, Chen W, Yang Z, Xu X, Liu L, et al. Anemiais associated with severe illness in COVID-19:A retrospective cohort study. J Med Virol.2021;93(3):1478−88. https://doi.org/10.1002/jmv.26444
Liu F, Xu A, Zhang Y, Xuan W, Yan T, Pan K, et al.Patients of COVID-19 may benefi t from sustainedLopinavir-combined regimen and the increase ofEosinophil may predict the outcome of COVID-19progression. Int J Infect Dis. 2020;95:183−91.https://doi.org/10.1016/j.ijid.2020.03.013
Hartl S, Breyer MK, Burghuber OC, OfenheimerA, Schrott A, Urban MH, et al. Bloodeosinophil count in the general population:typical values and potential confounders. EurRespir J. 2020;55(5):1901874. https://doi.org/10.1183/13993003.01874-2019
Caspard H, Ambrose CS, Tran TN, Chipps BE,Zeiger RS. Associations between individualcharacteristics and blood eosinophil countsin adults with asthma or COPD. J Allergy ClinImmunol Pract. 2020;8(5):1606‒13. https://doi.org/10.1016/j.jaip.2019.12.019
Kumar A, Cherian SV, Vassallo R, Yi ES, Ryu JH.Current concepts in pathogenesis, diagnosis,and management of smoking-related Interstitiallung diseases. Chest. 2018;154(2):394‒408.https://doi.org/10.1016/j.chest.2017.11.023.