key: cord-0885766-fa7f00ac authors: Bahadur, Shalini; Kalonia, Tushar; Kamini, Kanchan; Gupta, Bhumika; Kalhan, Shivani; Jain, Mansi title: Changes in peripheral blood in SARS CoV‐2 patients and its clinico‐pathological correlation: A prospective cross‐sectional study date: 2021-10-01 journal: Int J Lab Hematol DOI: 10.1111/ijlh.13720 sha: 4c54c94973d8bb84fc5517bc20de2ab99330e311 doc_id: 885766 cord_uid: fa7f00ac INTRODUCTION: Coronavirus disease 2019 (COVID‐19) caused by SARS‐CoV2 can present from mild flu‐like symptoms to acute respiratory distress syndrome. There is multi‐organ involvement; particularly, hematopoietic system can be associated with morphological changes in blood cells of COVID‐19 patients. METHOD: We conducted a cross‐sectional study on a cohort of 50 COVID‐19 patients, confirmed on RT‐PCR with documented cycle threshold (Ct) value. Peripheral blood sample of these patients was collected and examined for complete blood counts (CBC) on automated haematological analyser as well as Leishman‐stained blood smears to look for morphological changes in blood cells. Morphological changes were evaluated with reference to clinical severity and Ct value. Additionally, association between Ct value and clinical severity was also performed. Statistical tests were performed, and P value <.05 was considered significant. RESULTS: Mean age of our study group was 42.16 ± 15.55 years, with male preponderance. Most commonly observed peripheral blood changes were hypolobation (P value = .002) and toxic granules (P value = .005) in neutrophils, atypical granules with nucleolar prominence in lymphocytes, cytoplasmic granulation with clumped nuclear chromatin in monocytes, giant platelets and thrombocytopenia and normocytic normochromic anaemia. CONCLUSION: No association was found between clinical severity and Ct value as well as peripheral blood morphological changes with Ct value. We conclude that examination of peripheral smear coupled with complete blood count (CBC) is only partially supportive of disease pathogenesis and to assess the viral load other parameters should be utilised instead of relying solely on Ct value. A prospective cross-sectional study was undertaken at Government Institute of Medical Sciences, Greater Noida, on COVID-19 patients based on haematological changes encountered. 50 consecutive patients with confirmed COVID-19 infection following positive RT-PCR test were enrolled to the study after taking necessary approvals from the Institutional Ethics Committee. RT-PCR was conducted on nasopharyngeal and oropharyngeal swab collected by a trained technician and cycle threshold (Ct) value noted. Ct value denotes the number of amplification cycles required for the specific targeted gene to exceed a given threshold level; hence, it is an indirect method to quantify the number of viral RNA present in a given sample, and thus it is presumed inversely proportional to viral load. 14 The study group comprised 50 patients with RT-PCR-confirmed Table 3 ]. In an attempt to relate frequency of morphological changes observed in blood smear with the Ct values, no statistically significant results were obtained. [ Table 4 ]. The coronavirus disease 2019 emerged as a challenge globally not just in terms of medical therapies to counteract its onslaught but also due to its socioeconomic impact. 5 As documented, COVID-19 resulted in a markedly contagious disease caused by SARS-CoV-2. 6 It affected nearly 220 countries across the world with more than an World Health Organisation, Novel coronavirus (COVID-19) situation World Health Organisation, Naming the corona virus disease (COVID-19) and the virus that caused it Complex immune dysregulation in COVID-19 patients with severe respiratory failure Effect of non-pharmaceutical interventions to contain COVID-19 in China Coronavirus disease 2019 induces multi-lineage, morphologic changes in peripheral blood cells Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study Hematologic parameters in patients with COVID-19 infection Clinical characteristics of coronavirus disease 2019 in China Characteristics of peripheral lymphocyte subset alteration in COVID-19 pneumonia Reactive lymphocytes in patients with Covid-19 Plasmacytoid lymphocytes in SARS-CoV-2 infection (Covid-19) Leukoerythroblastic reaction in a patient with COVID-19 infection Morphological anomalies of circulating blood cells in COVID-19 Real-time reverse transcription PCR (qRT-PCR) and its potential use in clinical diagnosis Evidence Based Advisory on Correlation of COVID-19 Disease Severity with Ct Values of the Real Time RT-PCR Test: Indian Council of Medical Research, Department of Health Research, Ministry of Health And Family Welfare, Government of India False-negative of RT-PCR and prolonged nucleic acid conversion in COVID-19: rather than recurrence Impact of SARS-CoV-2 viral load on risk of intubation and mortality among hospitalized patients with coronavirus disease 2019 ICSH recommendations for the standardization of nomenclature and grading of peripheral blood cell morphological features Clinical Management Protocol: COVID-19, Government Of India, Ministry Of Health and Family Welfare, Directorate General of Health Services (EMR Division), Version 4 Peripheral blood smear morphology-A red flag in COVID-19 Morphology of COVID-19-affected cells in peripheral blood film A four-parameter index of marrow dysplasia has predictive value for myelodysplastic syndromes Hand-mirror lymphocytes in infectious mononucleosis Plasmacytoid lymphocytes: a diagnostic clue for dengue fever A systematic review of the clinical utility of cycle threshold values in the context of COVID-19 RT-PCR for SARS-CoV-2: quantitative versus qualitative No correlation between Ct values and severity of disease or mortality in patients with COVID 19 disease Covid test should track viral load too, says new ICMR study Chronological changes of viral shedding in adult inpatients with COVID-19 in Wuhan, China Correlation between relative nasopharyngeal virus RNA load and lymphocyte count disease severity in patients with COVID-19 Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury Changes in peripheral blood in SARS CoV-2 patients and its clinico-pathological correlation: A prospective cross-sectional study