Sandbox:Shakiba
Associate Editor(s)-in-Chief: Shakiba Hassanzadeh, MD[1]
Overview
COVID-19-Associated Hematologic 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
- Decrease in albumin
- Increase in interleukin-6 (IL-6)
- Thrombocytosis
Pathophysiology and Causes
- CRP is an acute phase reactant that increases in conditions with inflammation.[1]
- In sepsis, the activation and adherence of monocytes increase procalcitonin, therefore procalcitonin in a biomarker for sepsis and septic shock.[2]
- ALT is produced by liver cells and is increased in liver conditions.[1]
- LDH is expressed in almost all cells and an increase in LDH could be seen in damage to any of the cell types.[1]
- Bilirubin is produced by liver cells and increases in liver and biliary conditions.[1]
- Creatinin is produced in the liver and excreted by the kidneys; creatinine increases when there is decrease in glomerular filtration rate.[1]
- Increase in cardiac troponins are used for diagnosing myocardial infarction and acute coronary syndrome .[1]
- Albumin may be decreased in many conditions such as sepsis, renal disease or malnutrition.[1]
Epidemiology
- Leukocytosis is seen in 11.4% of patients with severe COVID-19 infection compared to 4.8% of patients with non-severe infection.[3][4]
- 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.[3][4]
- 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.[3][4]
- 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.[3][4]
- 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.[3][4]
- 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.[3][4]
- MDW was found to be increased in all patients with COVID-19 infection, particularly in those with the worst conditions.[4]
- 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.[3][4]
- Increase in creatinine is seen in 4.3% of patients with severe COVID-19 infection compared to 1% of patients with non-severe infection.[3][4]
- Thrombocytosis has been reported in 4% of patients with COVID-19 infection.[5]
Clinical Significance
Laboratory findings in COVID-19 infection may indicate clinical abnormalities, including:
- In patients with COVID-19 infection, leukocytosis may be an indication of a bacterial infection or superinfection.[4]
- In patients with COVID-19 infection, increase in CRP may be an indication of severe viral infection or sepsis and viremia.[4]
- In patients with COVID-19 infection, increase in procalcitonin may be an indication of bacterial infection or superinfection.[4]
- 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[6], while another one reports an association between increase in ferritin and death in COVID-19 infection[7]
- In patients with COVID-19 infection, increase in aminotransferases may indicate injury to the liver or multi-system damage.[4]
- In patients with COVID-19 infection, increase in aminotransferases may indicate injury to the liver or multi-system damage.[4]
- In patients with COVID-19 infection, increase in LDH may indicate injury to the lungs or multi-system damage.[4]
- In patients with COVID-19 infection, increase in total bilirubin may indicate injury to the liver.[4]
- In patients with COVID-19 infection, increase in creatinine may indicate injury to the kidneys.[4]
- In patients with COVID-19 infection, increase in cardiac troponins may indicate cardiac injury.[4]
- In patients with COVID-19 infection, decrease in albumin may indicate liver function abnormality.[4]
- Increase in IL-6 has been reported to be associated with death in COVID-19 infection.[6]
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 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). - ↑ 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.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7
- ↑ 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 4.11 4.12 4.13 4.14 4.15 4.16 4.17 4.18 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). - ↑ 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). - ↑ 6.0 6.1 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). - ↑ 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).