Frequency of Leukoerythroblastic Picture and Hematological Parameters in COVID-19 Patients and Association With Disease Severity

Abstract

Introduction: Patients infected by COVID-19 can present with severe lung damage and acute respiratory distress syndrome (ARDS) and have a significant mortality risk involving all body system such as cardiovascular (CVS), gastrointestinal (GIT), neurological (CNS), immune system and haemopoietic system.

Aims & Objectives: To determine frequency of Leukoerythroblastic picture, compare complete blood counts and cell ratios (NLR, PLR, LMR) of positive COVID-19 patients with suspected COVID-19 patients and their association with severity as stratified by mode of admission and clinical status.

Place and duration of study: King Edward Medical University, Mayo Hospital Lahore from December 2020 to January 2021.

Material &Methods: 75 RT-PCR confirmed COVID-19 and 75 suspected patients of both genders and aged above 18 years were included. Severity was classified by mode of admission and patient status. CBC samples of all patients were analyzed for counts, differential and LE picture on Sysmex XE-1000 automatic blood analyzer. NLR, LMR and PLR were calculated in both groups. Peripheral smear findings were noted for leukoerythroblastic picture in all patients.Data was analyzed using SPSS version 25, p value ?0.05 was considered significant.

Results: Each group consist of equal (75) number of patients with male predominance. Mean age of patient in confirmed and suspected groups were 58±14 and 61±15 respectively in both groups. Majority were admitted in HDU and ICU compared to isolated wards (P: .000). Frequency of LE picture in both groups was (2.7%) (P:0.12) by Chi-square. Mean± SD were determined, of hematological parameters and ratios in confirmed and suspected groups. ANC (P:0.022), ALC (P:0.032), NLR (P:0.002) were significantly different when compared in both groups.

Median (IQR) of Hb (p: 0.05), WBC (P: 0.000), platelet (P: 0.008), ANC (P: 0.000), NLR (P: 0.000), LMR (P: 0.016)

were significantly correlated with severity, when analyzed by independent-sample Kruskal Wallis Test.

Conclusion: Leukoerythroblastic picture is not associated with severity in COVID-19. Neutrophil to lymphocyte ratio is important prognostic factor in suspected and confirmed COVID-19 patients.