Hematological findings and complications of COVID-19

Am J Hematol. 2020 Jul;95(7):834-847. doi: 10.1002/ajh.25829. Epub 2020 May 23.

Abstract

COVID-19 is a systemic infection with a significant impact on the hematopoietic system and hemostasis. Lymphopenia may be considered as a cardinal laboratory finding, with prognostic potential. Neutrophil/lymphocyte ratio and peak platelet/lymphocyte ratio may also have prognostic value in determining severe cases. During the disease course, longitudinal evaluation of lymphocyte count dynamics and inflammatory indices, including LDH, CRP and IL-6 may help to identify cases with dismal prognosis and prompt intervention in order to improve outcomes. Biomarkers, such high serum procalcitonin and ferritin have also emerged as poor prognostic factors. Furthermore, blood hypercoagulability is common among hospitalized COVID-19 patients. Elevated D-Dimer levels are consistently reported, whereas their gradual increase during disease course is particularly associated with disease worsening. Other coagulation abnormalities such as PT and aPTT prolongation, fibrin degradation products increase, with severe thrombocytopenia lead to life-threatening disseminated intravascular coagulation (DIC), which necessitates continuous vigilance and prompt intervention. So, COVID-19 infected patients, whether hospitalized or ambulatory, are at high risk for venous thromboembolism, and an early and prolonged pharmacological thromboprophylaxis with low molecular weight heparin is highly recommended. Last but not least, the need for assuring blood donations during the pandemic is also highlighted.

Publication types

  • Systematic Review

MeSH terms

  • Anticoagulants / therapeutic use
  • Betacoronavirus*
  • Biomarkers
  • Blood Coagulation Tests
  • Blood Donors / supply & distribution
  • C-Reactive Protein / analysis
  • COVID-19
  • COVID-19 Testing
  • Clinical Laboratory Techniques
  • Coronavirus Infections / blood*
  • Coronavirus Infections / complications
  • Coronavirus Infections / diagnosis
  • Cytokine Release Syndrome / blood
  • Cytokine Release Syndrome / etiology
  • Cytokines / blood
  • Disseminated Intravascular Coagulation / blood
  • Disseminated Intravascular Coagulation / etiology
  • Early Diagnosis
  • Ferritins / blood
  • Fibrin Fibrinogen Degradation Products / analysis
  • Humans
  • Lymphopenia / etiology*
  • Meta-Analysis as Topic
  • Pandemics
  • Pneumonia, Viral / blood*
  • Pneumonia, Viral / complications
  • Pneumonia, Viral / diagnosis
  • Risk
  • SARS-CoV-2
  • Thrombophilia / blood
  • Thrombophilia / drug therapy
  • Thrombophilia / etiology*
  • Venous Thromboembolism / blood
  • Venous Thromboembolism / etiology
  • Venous Thromboembolism / prevention & control

Substances

  • Anticoagulants
  • Biomarkers
  • Cytokines
  • Fibrin Fibrinogen Degradation Products
  • fibrin fragment D
  • C-Reactive Protein
  • Ferritins