COVID-19 laboratory findings: Difference between revisions

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==Overview==
==Overview==
 
Some other hematological findings in [[COVID-19]] infection include: increase in [[C-reactive protein|C-reactive protein (CRP)]],  [[procalcitonin]], [[Aspartate aminotransferase|aspartate aminotransferase (AST)]], [[Alanine aminotransferase|alanine aminotransferase (ALT)]], total [[bilirubin]], cardiac [[Troponin|troponins]], decrease in [[albumin]] and [[leukocytosis]].
== Other Laboratory Findings ==
 
==== Leukocytosis ====
 
*
*
 
==== Increase in C-reactive protein (CRP)  ====
 
*
*
*
 
==== Increase in procalcitonin ====
 
*
*
*
 
==== Increase in ferritin ====
 
*.
 
==== Increase in aspartate aminotransferase (AST)  ====
 
*
*
 
==== Increase in alanine aminotransferase (ALT)  ====
 
*
*
*
 
==== Increase in lactate dehydrogenase (LDH) ====
 
*
*
*
 
==== Increase in monocyte volume distribution width (MDW) ====
 
*
 
==== Increase in total bilirubin ====
 
*
*
*
 
==== Increase in creatinine ====
 
*
*
*
 
==== Increase in cardiac troponins ====
 
*In
*
 
==== Decrease in albumin ====
 
*
*
 
==== Increase in interleukin-6 (IL-6) ====
 
*
 
 


==Historical Perspective==
==Historical Perspective==
Line 85: Line 14:


* On January 30, 2020, the [[outbreak]] was declared a Public Health Emergency of International Concern.
* On January 30, 2020, the [[outbreak]] was declared a Public Health Emergency of International Concern.
* On March 12, 2020, the COVID-19 outbreak was declared a [[pandemic]] by the [[World Health Organization|World Health Organization (WHO)]].
* On March 12, 2020, the [[COVID-19]] outbreak was declared a [[pandemic]] by the [[World Health Organization|World Health Organization (WHO)]].


== Other Hematological Findings ==
== Other Hematological Findings ==


* Leukocytosis
*[[Leukocytosis]]
* Increase in C-reactive protein (CRP)  
* Increase in [[C-reactive protein|C-reactive protein (CRP)]]
* Increase in procalcitonin
* Increase in [[procalcitonin]]
* Increase in ferritin
* Increase in [[ferritin]]
* Increase in aspartate aminotransferase (AST)  
* Increase in [[Aspartate aminotransferase|aspartate aminotransferase (AST)]]
*  Increase in alanine aminotransferase (ALT)  
*  Increase in [[Alanine aminotransferase|alanine aminotransferase (ALT)]]
* Increase in lactate dehydrogenase (LDH)
* Increase in [[Lactate dehydrogenase|lactate dehydrogenase (LDH)]]
* Increase in monocyte volume distribution width (MDW)
* Increase in monocyte volume distribution width (MDW)
* Increase in total bilirubin
* Increase in total [[bilirubin]]
* Increase in creatinine
* Increase in creatinine
* Increase in cardiac troponins
* Increase in cardiac [[Troponin|troponins]]
* Decrease in albumin
* Decrease in [[albumin]]
* Increase in interleukin-6 (IL-6)
* Increase in [[Interleukin-6|interleukin-6 (IL-6)]]
* Thrombocytosis
*[[Thrombocytosis]]


== Pathophysiology and Causes ==
== Pathophysiology and Causes ==


* CRP is an [[Acute phase protein|acute phase reactant]] that increases in conditions with inflammation.<ref name="pmid32311826">{{cite journal| author=Frater JL, Zini G, d'Onofrio G, Rogers HJ| title=COVID-19 and the clinical hematology laboratory. | journal=Int J Lab Hematol | year= 2020 | volume= 42 Suppl 1 | issue=  | pages= 11-18 | pmid=32311826 | doi=10.1111/ijlh.13229 | pmc=7264622 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32311826  }} </ref>
* CRP is an [[Acute phase protein|acute phase reactant]] that increases in conditions with inflammation.<ref name="pmid32311826">{{cite journal| author=Frater JL, Zini G, d'Onofrio G, Rogers HJ| title=COVID-19 and the clinical hematology laboratory. | journal=Int J Lab Hematol | year= 2020 | volume= 42 Suppl 1 | issue=  | pages= 11-18 | pmid=32311826 | doi=10.1111/ijlh.13229 | pmc=7264622 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32311826  }} </ref>
* In sepsis, the activation and adherence of [[Monocyte|monocytes]] increase [[procalcitonin]], therefore [[procalcitonin]] in a biomarker for sepsis and septic shock.<ref name="pmid24982830">{{cite journal| author=Meisner M| title=Update on procalcitonin measurements. | journal=Ann Lab Med | year= 2014 | volume= 34 | issue= 4 | pages= 263-73 | pmid=24982830 | doi=10.3343/alm.2014.34.4.263 | pmc=4071182 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24982830  }} </ref>
* In [[sepsis]], the activation and adherence of [[Monocyte|monocytes]] increase [[procalcitonin]], therefore [[procalcitonin]] in a biomarker for sepsis and septic shock.<ref name="pmid24982830">{{cite journal| author=Meisner M| title=Update on procalcitonin measurements. | journal=Ann Lab Med | year= 2014 | volume= 34 | issue= 4 | pages= 263-73 | pmid=24982830 | doi=10.3343/alm.2014.34.4.263 | pmc=4071182 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24982830  }} </ref>
* [[Alanine transaminase|ALT]] is produced by liver cells and is increased in liver conditions.<ref name="pmid32311826" />
* [[Alanine transaminase|ALT]] is produced by liver cells and is increased in liver conditions.<ref name="pmid32311826" />
* LDH is expressed in almost all cells and an increase in [[LDH]] could be seen in damage to any of the cell types.<ref name="pmid32311826" />
*[[Lactate dehydrogenase|LDH]] is expressed in almost all cells and an increase in [[LDH]] could be seen in damage to any of the cell types.<ref name="pmid32311826" />
* Bilirubin  is produced by liver cells and increases in liver and biliary conditions.<ref name="pmid32311826" />
*[[Bilirubin]]  is produced by liver cells and increases in liver and biliary conditions.<ref name="pmid32311826" />
* Creatinin is produced in the liver and excreted by the kidneys; [[creatinine]] increases when there is decrease in [[glomerular filtration rate]].<ref name="pmid32311826" />
* Creatinin is produced in the liver and excreted by the kidneys; [[creatinine]] increases when there is decrease in [[glomerular filtration rate]].<ref name="pmid32311826" />
* Increase in cardiac troponins are used for diagnosing myocardial infarction and [[Acute coronary syndromes|acute coronary syndrome]] .<ref name="pmid32311826" />
* Increase in cardiac [[Troponin|troponins]] are used for diagnosing myocardial infarction and [[Acute coronary syndromes|acute coronary syndrome]] .<ref name="pmid32311826" />
* [[Albumin]] may be decreased in many conditions such as [[sepsis]], renal disease or [[malnutrition]].<ref name="pmid32311826" />
* [[Albumin]] may be decreased in many conditions such as [[sepsis]], renal disease or [[malnutrition]].<ref name="pmid32311826" />


Line 126: Line 55:
* Increase in total bilirubin is seen in 13.3% of patients with severe [[COVID-19]] infection compared to 9.9% of patients with non-severe infection.<ref name="pmid32109013" /><ref name="pmid32191623" />
* Increase in total bilirubin is seen in 13.3% of patients with severe [[COVID-19]] infection compared to 9.9% of patients with non-severe infection.<ref name="pmid32109013" /><ref name="pmid32191623" />
* Increase in [[creatinine]] is seen in 4.3% of patients with severe [[COVID-19]] infection compared to 1% of patients with non-severe infection.<ref name="pmid32109013" /><ref name="pmid32191623" />
* Increase in [[creatinine]] is seen in 4.3% of patients with severe [[COVID-19]] infection compared to 1% of patients with non-severe infection.<ref name="pmid32109013" /><ref name="pmid32191623" />
*Thrombocytosis has been reported in 4% of patients with [[COVID-19]] infection.<ref name="pmid32007143">{{cite journal| author=Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y | display-authors=etal| title=Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. | journal=Lancet | year= 2020 | volume= 395 | issue= 10223 | pages= 507-513 | pmid=32007143 | doi=10.1016/S0140-6736(20)30211-7 | pmc=7135076 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32007143  }} </ref>
*[[Thrombocytosis]] has been reported in 4% of patients with [[COVID-19]] infection.<ref name="pmid32007143">{{cite journal| author=Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y | display-authors=etal| title=Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. | journal=Lancet | year= 2020 | volume= 395 | issue= 10223 | pages= 507-513 | pmid=32007143 | doi=10.1016/S0140-6736(20)30211-7 | pmc=7135076 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32007143  }} </ref>


== Clinical Significance ==
== Clinical Significance ==
Laboratory findings in [[COVID-19]] infection may indicated clinical abnormalities, including:
Laboratory findings in [[COVID-19]] infection may indicated clinical abnormalities, including:


* In patients with COVID-19 infection, leukocytosis may be an indication of a bacterial infection or superinfection.<ref name="pmid32191623" />
* In patients with [[COVID-19]] infection, leukocytosis may be an indication of a bacterial infection or superinfection.<ref name="pmid32191623" />
* In patients with COVID-19 infection, increase in [[CRP]] may be an indication of severe viral infection or [[sepsis]] and [[viremia]].<ref name="pmid32191623" />
* In patients with [[COVID-19]] infection, increase in [[CRP]] may be an indication of severe viral infection or [[sepsis]] and [[viremia]].<ref name="pmid32191623" />
* In patients with COVID-19 infection, increase in [[procalcitonin]] may be an indication of bacterial infection or [[superinfection]].<ref name="pmid32191623" />
* In patients with [[COVID-19]] infection, increase in [[procalcitonin]] may be an indication of bacterial infection or [[superinfection]].<ref name="pmid32191623" />
* There have been different reports regarding the association of increase in [[ferritin]] with death in COVID-19 infection; for example, there has been a report that increase in [[ferritin]] is associated with [[Acute respiratory distress syndrome|acute respiratory distress syndrome (ARDS)]] but not death<ref name="pmid32167524">{{cite journal| author=Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S | display-authors=etal| title=Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. | journal=JAMA Intern Med | year= 2020 | volume=  | issue=  | pages=  | pmid=32167524 | doi=10.1001/jamainternmed.2020.0994 | pmc=7070509 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32167524  }} </ref>, while another one reports an association between increase in [[ferritin]] and death in COVID-19 infection<ref name="pmid32171076">{{cite journal| author=Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z | display-authors=etal| title=Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. | journal=Lancet | year= 2020 | volume= 395 | issue= 10229 | pages= 1054-1062 | pmid=32171076 | doi=10.1016/S0140-6736(20)30566-3 | pmc=7270627 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32171076  }} </ref>
* There have been different reports regarding the association of increase in [[ferritin]] with death in COVID-19 infection; for example, there has been a report that increase in [[ferritin]] is associated with [[Acute respiratory distress syndrome|acute respiratory distress syndrome (ARDS)]] but not death<ref name="pmid32167524">{{cite journal| author=Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S | display-authors=etal| title=Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. | journal=JAMA Intern Med | year= 2020 | volume=  | issue=  | pages=  | pmid=32167524 | doi=10.1001/jamainternmed.2020.0994 | pmc=7070509 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32167524  }} </ref>, while another one reports an association between increase in [[ferritin]] and death in COVID-19 infection<ref name="pmid32171076">{{cite journal| author=Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z | display-authors=etal| title=Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. | journal=Lancet | year= 2020 | volume= 395 | issue= 10229 | pages= 1054-1062 | pmid=32171076 | doi=10.1016/S0140-6736(20)30566-3 | pmc=7270627 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32171076  }} </ref>
* In patients with [[COVID-19]] infection, increase in [[aminotransferases]] may indicate injury to the [[liver]] or multi-system damage.<ref name="pmid32191623" />
* In patients with [[COVID-19]] infection, increase in [[aminotransferases]] may indicate injury to the [[liver]] or multi-system damage.<ref name="pmid32191623" />
* In patients with [[COVID-19]] infection, increase in [[aminotransferases]] may indicate injury to the liver or multi-system damage.<ref name="pmid32191623" />
* In patients with [[COVID-19]] infection, increase in [[aminotransferases]] may indicate injury to the liver or multi-system damage.<ref name="pmid32191623" />
* In patients with COVID-19 infection, increase in [[Lactate dehydrogenase|LDH]] may indicate injury to the lungs or multi-system damage.<ref name="pmid32191623" />
* In patients with [[COVID-19]] infection, increase in [[Lactate dehydrogenase|LDH]] may indicate injury to the lungs or multi-system damage.<ref name="pmid32191623" />
* In patients with COVID-19 infection, increase in total bilirubin may indicate injury to the liver.<ref name="pmid32191623" />
* In patients with [[COVID-19]] infection, increase in total bilirubin may indicate injury to the liver.<ref name="pmid32191623" />
* In patients with COVID-19 infection, increase in [[creatinine]] may indicate injury to the kidneys.<ref name="pmid32191623" />
* In patients with [[COVID-19]] infection, increase in [[creatinine]] may indicate injury to the kidneys.<ref name="pmid32191623" />
* In patients with COVID-19 infection, increase in cardiac troponins may indicate cardiac injury.<ref name="pmid32191623" />
* In patients with [[COVID-19]] infection, increase in cardiac troponins may indicate cardiac injury.<ref name="pmid32191623" />
* In patients with COVID-19 infection, decrease in [[albumin]] may indicate liver function abnormality.<ref name="pmid32191623" />
* In patients with [[COVID-19]] infection, decrease in [[albumin]] may indicate liver function abnormality.<ref name="pmid32191623" />
* Increase in [[IL-6]] has been reported to be associated with death in COVID-19 infection.<ref name="pmid32167524" />
* Increase in [[IL-6]] has been reported to be associated with death in [[COVID-19]] infection.<ref name="pmid32167524" />


*  
*  
==Classification==
There is no established system for the classification of [disease name].
OR
[Disease name] may be classified according to [classification method] into [number] subtypes/groups: [group1], [group2], [group3], and [group4].
OR
[Disease name] may be classified into [large number > 6] subtypes based on [classification method 1], [classification method 2], and [classification method 3].
[Disease name] may be classified into several subtypes based on [classification method 1], [classification method 2], and [classification method 3].
OR
Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.
OR
If the staging system involves specific and characteristic findings and features:
According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].
OR
The staging of [malignancy name] is based on the [staging system].
OR
There is no established system for the staging of [malignancy name].
==Pathophysiology==
The exact pathogenesis of [disease name] is not fully understood.
OR
It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].
OR
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.
OR
Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
OR
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
OR
The progression to [disease name] usually involves the [molecular pathway].
OR
The pathophysiology of [disease/malignancy] depends on the histological subtype.
==Causes==
Disease name] may be caused by [cause1], [cause2], or [cause3].
OR
Common causes of [disease] include [cause1], [cause2], and [cause3].
OR
The most common cause of [disease name] is [cause 1]. Less common causes of [disease name] include [cause 2], [cause 3], and [cause 4].
OR
The cause of [disease name] has not been identified. To review risk factors for the development of [disease name], click [[Pericarditis causes#Overview|here]].
==Differentiating ((Page name)) from other Diseases==
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
OR
[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
==Epidemiology and Demographics==
The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide.
OR
In [year], the incidence/prevalence of [disease name] was estimated to be [number range] cases per 100,000 individuals worldwide.
OR
In [year], the incidence of [disease name] is approximately [number range] per 100,000 individuals with a case-fatality rate of [number range]%.
Patients of all age groups may develop [disease name].
OR
The incidence of [disease name] increases with age; the median age at diagnosis is [#] years.
OR
[Disease name] commonly affects individuals younger than/older than [number of years] years of age.
OR
[Chronic disease name] is usually first diagnosed among [age group].
OR
[Acute disease name] commonly affects [age group].
There is no racial predilection to [disease name].
OR
[Disease name] usually affects individuals of the [race 1] race. [Race 2] individuals are less likely to develop [disease name].
[Disease name] affects men and women equally.
OR
[Gender 1] are more commonly affected by [disease name] than [gender 2]. The [gender 1] to [gender 2] ratio is approximately [number > 1] to 1.
The majority of [disease name] cases are reported in [geographical region].
OR
[Disease name] is a common/rare disease that tends to affect [patient population 1] and [patient population 2].
==Risk Factors==
There are no established risk factors for [disease name].
OR
The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].
OR
Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
OR
Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.
==Screening==
There is insufficient evidence to recommend routine screening for [disease/malignancy].
OR
According to the [guideline name], screening for [disease name] is not recommended.
OR
According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].
==Natural History, Complications, and Prognosis==
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
OR
Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
OR
Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
==Diagnosis==
===Diagnostic Study of Choice===
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
OR
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
OR
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
OR
There are no established criteria for the diagnosis of [disease name].
===History and Symptoms===
The majority of patients with [disease name] are asymptomatic.
OR
The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
===Physical Examination===
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
OR
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
OR
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
===Laboratory Findings===
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].
OR
Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
OR
[Test] is usually normal among patients with [disease name].
OR
Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
OR
There are no diagnostic laboratory findings associated with [disease name].
===Electrocardiogram===
There are no ECG findings associated with [disease name].
OR
An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
===X-ray===
There are no x-ray findings associated with [disease name].
OR
An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound  findings associated with [disease name].
OR
Echocardiography/ultrasound  may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no echocardiography/ultrasound  findings associated with [disease name]. However, an echocardiography/ultrasound  may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
===CT scan===
There are no CT scan findings associated with [disease name].
OR
[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
===MRI===
There are no MRI findings associated with [disease name].
OR
[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
===Other Imaging Findings===
There are no other imaging findings associated with [disease name].
OR
[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
===Other Diagnostic Studies===
There are no other diagnostic studies associated with [disease name].
OR
[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].
==Treatment==
===Medical Therapy===
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
OR
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
OR
The majority of cases of [disease name] are self-limited and require only supportive care.
OR
[Disease name] is a medical emergency and requires prompt treatment.
OR
The mainstay of treatment for [disease name] is [therapy].
OR
 
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
OR
[Therapy] is recommended among all patients who develop [disease name].
OR
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
OR
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
OR
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
OR
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
===Surgery===
Surgical intervention is not recommended for the management of [disease name].
OR
Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]
OR
The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].
OR
The feasibility of surgery depends on the stage of [malignancy] at diagnosis.
OR
Surgery is the mainstay of treatment for [disease or malignancy].
===Primary Prevention===
There are no established measures for the primary prevention of [disease name].
OR
There are no available vaccines against [disease name].
OR
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==References==
==References==

Revision as of 14:38, 27 June 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shakiba Hassanzadeh, MD[2]

Synonyms and keywords:

Overview

Some other hematological findings in COVID-19 infection include: increase in C-reactive protein (CRP), procalcitonin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin, cardiac troponins, decrease in albumin and leukocytosis.

Historical Perspective

Other Hematological Findings

Pathophysiology and Causes

Epidemiology

  • Leukocytosis is seen in 11.4% of patients with severe COVID-19 infection compared to 4.8% of patients with non-severe infection.[5][6]
  • Increase in CRP is seen in 81.5% of patients with severe COVID-19 infection compared to 56.4% of patients with non-severe infection.[5][6]
  • Increase in procalcitonin is seen in 13.7% of patients with severe COVID-19 infection compared to 3.7% of patients with non-severe infection.[5][6]
  • Increase in AST is seen in 39.4% of patients with severe COVID-19 infection compared to 18.2% of patients with non-severe infection.[5][6]
  • Increase in ALT is seen in 28.1% of patients with severe COVID-19 infection compared to 19.8% of patients with non-severe infection.[5][6]
  • Increase in LDH is seen in 58.1% of patients with severe COVID-19 infection compared to 37.2% of patients with non-severe infection.[5][6]
  • MDW was found to be increased in all patients with COVID-19 infection, particularly in those with the worst conditions.[6]
  • Increase in total bilirubin is seen in 13.3% of patients with severe COVID-19 infection compared to 9.9% of patients with non-severe infection.[5][6]
  • Increase in creatinine is seen in 4.3% of patients with severe COVID-19 infection compared to 1% of patients with non-severe infection.[5][6]
  • Thrombocytosis has been reported in 4% of patients with COVID-19 infection.[7]

Clinical Significance

Laboratory findings in COVID-19 infection may indicated clinical abnormalities, including:

  • In patients with COVID-19 infection, leukocytosis may be an indication of a bacterial infection or superinfection.[6]
  • In patients with COVID-19 infection, increase in CRP may be an indication of severe viral infection or sepsis and viremia.[6]
  • In patients with COVID-19 infection, increase in procalcitonin may be an indication of bacterial infection or superinfection.[6]
  • There have been different reports regarding the association of increase in ferritin with death in COVID-19 infection; for example, there has been a report that increase in ferritin is associated with acute respiratory distress syndrome (ARDS) but not death[8], while another one reports an association between increase in ferritin and death in COVID-19 infection[9]
  • In patients with COVID-19 infection, increase in aminotransferases may indicate injury to the liver or multi-system damage.[6]
  • In patients with COVID-19 infection, increase in aminotransferases may indicate injury to the liver or multi-system damage.[6]
  • In patients with COVID-19 infection, increase in LDH may indicate injury to the lungs or multi-system damage.[6]
  • In patients with COVID-19 infection, increase in total bilirubin may indicate injury to the liver.[6]
  • In patients with COVID-19 infection, increase in creatinine may indicate injury to the kidneys.[6]
  • In patients with COVID-19 infection, increase in cardiac troponins may indicate cardiac injury.[6]
  • In patients with COVID-19 infection, decrease in albumin may indicate liver function abnormality.[6]
  • Increase in IL-6 has been reported to be associated with death in COVID-19 infection.[8]

References

  1. ↑ https://www.cdc.gov/coronavirus/2019-ncov/about/index.html. Missing or empty |title= (help)
  2. ↑ Lu, Jian; Cui, Jie; Qian, Zhaohui; Wang, Yirong; Zhang, Hong; Duan, Yuange; Wu, Xinkai; Yao, Xinmin; Song, Yuhe; Li, Xiang; Wu, Changcheng; Tang, Xiaolu (2020). "On the origin and continuing evolution of SARS-CoV-2". National Science Review. doi:10.1093/nsr/nwaa036. ISSN 2095-5138.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Frater JL, Zini G, d'Onofrio G, Rogers HJ (2020). "COVID-19 and the clinical hematology laboratory". Int J Lab Hematol. 42 Suppl 1: 11–18. doi:10.1111/ijlh.13229. PMC 7264622 Check |pmc= value (help). PMID 32311826 Check |pmid= value (help).
  4. ↑ Meisner M (2014). "Update on procalcitonin measurements". Ann Lab Med. 34 (4): 263–73. doi:10.3343/alm.2014.34.4.263. PMC 4071182. PMID 24982830.
  5. ↑ 5.0 5.1 5.2 5.3 5.4 5.5 5.6 5.7
  6. ↑ 6.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.09 6.10 6.11 6.12 6.13 6.14 6.15 6.16 6.17 6.18 Lippi G, Plebani M (2020). "The critical role of laboratory medicine during coronavirus disease 2019 (COVID-19) and other viral outbreaks". Clin Chem Lab Med. 58 (7): 1063–1069. doi:10.1515/cclm-2020-0240. PMID 32191623 Check |pmid= value (help).
  7. ↑ Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y; et al. (2020). "Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study". Lancet. 395 (10223): 507–513. doi:10.1016/S0140-6736(20)30211-7. PMC 7135076 Check |pmc= value (help). PMID 32007143 Check |pmid= value (help).
  8. ↑ 8.0 8.1 Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S; et al. (2020). "Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China". JAMA Intern Med. doi:10.1001/jamainternmed.2020.0994. PMC 7070509 Check |pmc= value (help). PMID 32167524 Check |pmid= value (help).
  9. ↑ Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z; et al. (2020). "Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study". Lancet. 395 (10229): 1054–1062. doi:10.1016/S0140-6736(20)30566-3. PMC 7270627 Check |pmc= value (help). PMID 32171076 Check |pmid= value (help).


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