Hematologic disorders associated with COVID-19: a review

Ann Hematol. 2021 Feb;100(2):309-320. doi: 10.1007/s00277-020-04366-y. Epub 2021 Jan 7.


Coronavirus disease 2019 is caused by severe acute respiratory syndrome coronavirus 2. Primarily an infection of the lower respiratory tract, it is now well known to cause multisystem abnormalities. Hematologic manifestations constitute a significant area of concern. Severe acute respiratory syndrome coronavirus 2 infects monocytes and endothelial cells leading to a complex downstream cascade, cytokine storm, and eventual intravascular thrombosis. Coronavirus disease 2019 causes lymphopenia, neutrophilia, and thrombocytopenia. Prophylactic anticoagulation is vital in patients with coronavirus disease 2019, as its effect on the coagulation system is associated with significant morbidity and mortality. The disease can cause both arterial and venous thromboses, especially pulmonary embolism and pulmonary microthrombi. A high index of suspicion is indispensable in recognizing these complications, and timely institution of therapeutic anticoagulation is vital in treating them. Virus-induced disseminated intravascular coagulation is uncommon but shares some similarities to sepsis-induced disseminated intravascular coagulation. Marked elevations in hematologic biomarkers such as lactate dehydrogenase, D-dimer, ferritin, and C-reactive protein are associated with worse outcomes. Understanding the pathophysiology and recognizing factors associated with poor prognosis are crucial in improving patient outcomes with coronavirus disease 2019.

Keywords: COVID-19; Cytokine storm; Pulmonary embolism; SARS-CoV-2.

Publication types

  • Review

MeSH terms

  • Anticoagulants / therapeutic use*
  • Biomarkers / blood
  • COVID-19 / complications*
  • COVID-19 / prevention & control
  • COVID-19 / virology
  • Ferritins / blood
  • Fibrin Fibrinogen Degradation Products / analysis
  • Hematologic Diseases / blood
  • Hematologic Diseases / complications
  • Hematologic Diseases / drug therapy
  • Humans
  • Lymphopenia / blood
  • Lymphopenia / complications
  • Lymphopenia / drug therapy
  • SARS-CoV-2 / isolation & purification*
  • SARS-CoV-2 / physiology
  • Thrombocytopenia / blood
  • Thrombocytopenia / complications
  • Thrombocytopenia / drug therapy


  • Anticoagulants
  • Biomarkers
  • Fibrin Fibrinogen Degradation Products
  • fibrin fragment D
  • Ferritins