COVID-19 Hematologic Complications

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

Overview

Complications

Lymphopenia

Neutrophilia

Thrombocytopenia

There is an association between severe COVID-19 infection and thrombocytopenia.[1] Thrombocytopenia is seen in 57.7% of patients with severe COVID-19 infection compared to 31.6 % of patients with non-severe infection.[2]

The pathogenesis of thrombocytopenia in COVID-19 infection is due to several factors:[3]

  1. Decrease in primary platelet production due to:
    • Infection of bone marrow cells by coronaviruses[4] and inhibition of bone marrow growth,[5] which lead to abnormal hematopoietic function
    • Cytokine storm caused by COVID-19 infection results in the destruction of bone marrow progenitor cells (XU)
  2. Increase in platelet destruction due to increase in autoantibodies and immune complexes[6] (XU)
  3. Decrease in circulating platelet due to lung injury which causes
    • Activation of platelets that result in platelet aggregation and formation of microthrombus  which lead to increase in platelet consumption XU)
    • Decrease in pulmonary capillary bed and megakaryocyte fragmentation result in decrease in platelet production[7] (XU)

Decrease in hemoglobulin

Other hematological findings

References

  1. ↑ Lippi G, Plebani M, Henry BM (2020). "Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis". Clin Chim Acta. 506: 145–148. doi:10.1016/j.cca.2020.03.022. PMC 7102663 Check |pmc= value (help). PMID 32178975 Check |pmid= value (help).
  2. ↑ Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX; et al. (2020). "Clinical Characteristics of Coronavirus Disease 2019 in China". N Engl J Med. 382 (18): 1708–1720. doi:10.1056/NEJMoa2002032. PMC 7092819 Check |pmc= value (help). PMID 32109013 Check |pmid= value (help).
  3. ↑ Xu P, Zhou Q, Xu J (2020). "Mechanism of thrombocytopenia in COVID-19 patients". Ann Hematol. 99 (6): 1205–1208. doi:10.1007/s00277-020-04019-0. PMC 7156897 Check |pmc= value (help). PMID 32296910 Check |pmid= value (help).
  4. ↑ Yang M, Ng MH, Li CK (2005). "Thrombocytopenia in patients with severe acute respiratory syndrome (review)". Hematology. 10 (2): 101–5. doi:10.1080/10245330400026170. PMID 16019455.
  5. ↑ Yeager CL, Ashmun RA, Williams RK, Cardellichio CB, Shapiro LH, Look AT; et al. (1992). "Human aminopeptidase N is a receptor for human coronavirus 229E". Nature. 357 (6377): 420–2. doi:10.1038/357420a0. PMC 7095410 Check |pmc= value (help). PMID 1350662.
  6. ↑ Nardi M, Tomlinson S, Greco MA, Karpatkin S (2001). "Complement-independent, peroxide-induced antibody lysis of platelets in HIV-1-related immune thrombocytopenia". Cell. 106 (5): 551–61. doi:10.1016/s0092-8674(01)00477-9. PMID 11551503.
  7. ↑ Lefrançais E, Ortiz-Muñoz G, Caudrillier A, Mallavia B, Liu F, Sayah DM; et al. (2017). "The lung is a site of platelet biogenesis and a reservoir for haematopoietic progenitors". Nature. 544 (7648): 105–109. doi:10.1038/nature21706. PMC 5663284. PMID 28329764.
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