COVID-19 Hematologic Complications

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ramyar Ghandriz MD[2], Shakiba Hassanzadeh, MD. Ifrah Fatima, M.B.B.S[3]

Overview

Recent pandemic of COVID-19 infection is shown to have multi-systemic complication. Hematologic complication of COVID-19 include Lymphopenia, Neutrophilia, Thrombocytopenia. some articles suggest that Hemoglobin may decrease in the event of disease.

Complications

Lymphopenia

There is an assosiation between sever COVID-19 infection and lymphopenia.[1]

Neutrophilia

The human body fights infections by recruiting neutrophils early to the sites of infection by oxidative burst and phagocytosis [2].New evidence suggests that the severe symptoms of COVID-19, including Acute Respiratory Distress Syndrome (ARDS), could be caused by Neutrophil Extracellular Traps (NETs)[3]. The neutrophil-to-lymphocyte ratio (NLR) has been identified as the independent risk factor for severe illness in patients with the 2019 novel coronavirus disease[4].

Thrombocytopenia

There is an association between severe COVID-19 infection and thrombocytopenia.[5] Thrombocytopenia is seen in 57.7% of patients with severe COVID-19 infection compared to 31.6 % of patients with non-severe infection.[6]

The pathogenesis of thrombocytopenia in COVID-19 infection is due to several factors:[7]

  • Decrease in primary platelet production due to infection of bone marrow cells by coronaviruses[8] and inhibition of bone marrow growth,[9] which lead to abnormal hematopoietic function.[7]
  • Increase in platelet destruction due to increase in auto-antibodies and immune complexes.[10]
  • Decrease in circulating platelet due to lung injury which causes megakaryocyte fragmentation and decreases platelet production, because lung is a reservoir for megakaryocyte and hematopoieitic progenitor cells and has a role in platelet production.[7][11] In addition, decrease in platelets may be due to activation of platelets that result in platelet aggregation and formation of microthrombus which increase platelet consumption.[7][12]

Hemoglobin decrease

Hypercoagulability

Other hematological findings

References

  1. ↑ Tan, Li; Wang, Qi; Zhang, Duanyang; Ding, Jinya; Huang, Qianchuan; Tang, Yi-Quan; Wang, Qiongshu; Miao, Hongming (2020). "Lymphopenia predicts disease severity of COVID-19: a descriptive and predictive study". Signal Transduction and Targeted Therapy. 5 (1). doi:10.1038/s41392-020-0148-4. ISSN 2059-3635.
  2. ↑ "Targeting potential drivers of COVID-19: Neutrophil extracellular traps | Journal of Experimental Medicine | Rockefeller University Press".
  3. ↑ "Severe COVID-19 symptoms may be caused by overactive neutrophils".
  4. ↑ "Neutrophil-to-Lymphocyte Ratio Predicts Severe Illness Patients with 2019 Novel Coronavirus in the Early Stage | medRxiv".
  5. ↑ Lippi G, Plebani M, Henry BM (2020). "Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis". Clin Chim Acta. 506: 145–148. doi:10.1016/j.cca.2020.03.022. PMC 7102663 Check |pmc= value (help). PMID 32178975 Check |pmid= value (help).
  6. ↑ Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX; et al. (2020). "Clinical Characteristics of Coronavirus Disease 2019 in China". N Engl J Med. 382 (18): 1708–1720. doi:10.1056/NEJMoa2002032. PMC 7092819 Check |pmc= value (help). PMID 32109013 Check |pmid= value (help).
  7. ↑ 7.0 7.1 7.2 7.3 Xu P, Zhou Q, Xu J (2020). "Mechanism of thrombocytopenia in COVID-19 patients". Ann Hematol. 99 (6): 1205–1208. doi:10.1007/s00277-020-04019-0. PMC 7156897 Check |pmc= value (help). PMID 32296910 Check |pmid= value (help).
  8. ↑ Yang M, Ng MH, Li CK (2005). "Thrombocytopenia in patients with severe acute respiratory syndrome (review)". Hematology. 10 (2): 101–5. doi:10.1080/10245330400026170. PMID 16019455.
  9. ↑ Yeager CL, Ashmun RA, Williams RK, Cardellichio CB, Shapiro LH, Look AT; et al. (1992). "Human aminopeptidase N is a receptor for human coronavirus 229E". Nature. 357 (6377): 420–2. doi:10.1038/357420a0. PMC 7095410 Check |pmc= value (help). PMID 1350662.
  10. ↑ Nardi M, Tomlinson S, Greco MA, Karpatkin S (2001). "Complement-independent, peroxide-induced antibody lysis of platelets in HIV-1-related immune thrombocytopenia". Cell. 106 (5): 551–61. doi:10.1016/s0092-8674(01)00477-9. PMID 11551503.
  11. ↑ Lefrançais E, Ortiz-Muñoz G, Caudrillier A, Mallavia B, Liu F, Sayah DM; et al. (2017). "The lung is a site of platelet biogenesis and a reservoir for haematopoietic progenitors". Nature. 544 (7648): 105–109. doi:10.1038/nature21706. PMC 5663284. PMID 28329764.
  12. ↑ Liu X, Zhang R, He G (2020). "Hematological findings in coronavirus disease 2019: indications of progression of disease". Ann Hematol. doi:10.1007/s00277-020-04103-5. PMC 7266734 Check |pmc= value (help). PMID 32495027 Check |pmid= value (help).
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