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. 2020 Aug 5;154(3):319-329.
doi: 10.1093/ajcp/aqaa108.

Peripheral Blood Examination Findings in SARS-CoV-2 Infection

Alia Nazarullah  1 , Christine Liang  1 , Andrew Villarreal  2 , Russell A Higgins  1 , Daniel D Mais  1
Affiliations

Peripheral Blood Examination Findings in SARS-CoV-2 Infection

Alia Nazarullah et al. Am J Clin Pathol. .

Abstract

Objectives: Peripheral blood abnormalities in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have not been fully elucidated. We report qualitative and quantitative peripheral blood findings in coronavirus disease 2019 (COVID-19) patients and compare them with a control group.

Methods: We reviewed electronic medical records, complete blood counts, peripheral blood smears, and flow cytometry data in 12 patients with SARS-CoV-2. These were compared with 10 control patients with symptoms suspicious for SARS-CoV-2 but who tested negative.

Results: No significant differences were noted in blood counts, except that absolute lymphopenia was present frequently in the control group (P < .05). Acquired Pelger-Huët anomaly (APHA) was noted in all COVID-19 cases, in most cases affecting over 5% of granulocytes. This contrasted with APHA in only 50% of control cases, affecting fewer than 5% of granulocytes in all cases (P < .05). Monolobate neutrophils were exclusive to COVID-19 cases. COVID-19 patients had greater frequency of plasmacytoid lymphocytes (P < .05). Flow cytometry data revealed absolute CD3+ T-cell count reduction in 6 of 7 patients; all of them required mechanical ventilation.

Conclusions: Lymphopenia was infrequent in our COVID-19 cohort; however, flow cytometric analysis revealed absolute T-cell count reduction in most cases. COVID-19 cases had significant APHA with monolobate neutrophils and plasmacytoid lymphocytes as compared to controls.

Keywords: COVID-19; Coronavirus; Hematologic; Peripheral blood; Peripheral smear; SARS-CoV-2.

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Figures

Image 1
Image 1
Morphologic findings in peripheral smears in coronavirus disease 2019 patients (Wright stain, ×100). A, Acquired Pelger-Huët anomaly. B, Monolobate neutrophil. C, Apoptotic neutrophil. D, Left shift to blast stage. E, Atypical lymphocyte with irregular nuclear contours. F, Plasmacytoid lymphocyte. G, Downey type I lymphocyte. H, Downey type II lymphocyte. I, Downey type III lymphocyte. J, Large granular lymphocyte.
Image 1
Image 1
Morphologic findings in peripheral smears in coronavirus disease 2019 patients (Wright stain, ×100). A, Acquired Pelger-Huët anomaly. B, Monolobate neutrophil. C, Apoptotic neutrophil. D, Left shift to blast stage. E, Atypical lymphocyte with irregular nuclear contours. F, Plasmacytoid lymphocyte. G, Downey type I lymphocyte. H, Downey type II lymphocyte. I, Downey type III lymphocyte. J, Large granular lymphocyte.
See this image and copyright information in PMC

References

    1. Zhu N, Zhang D, Wang W, et al. . A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382:727-733. - PMC - PubMed
    1. Lu R, Zhao X, Li J, et al. . Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020;395:565-574. - PMC - PubMed
    1. Tay MZ, Poh CM, Rénia L, et al. . The trinity of COVID-19: immunity, inflammation and intervention. Nat Rev Immunol. 2020;1-12. doi:10.1038/s41577-020-0311-8. - DOI - PMC - PubMed
    1. Huang C, Wang Y, Li X, et al. . Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China [published correction appears in Lancet. 2020 Jan 30]. Lancet. 2020;395:497-506. - PMC - PubMed
    1. Chen N, Zhou M, Dong X, et al. . Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395:507-513. - PMC - PubMed