COVID-19-associated lymphopenia

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

Synonyms and keywords:

Overview

Coronavirus disease 2019 (COVID-19) has been considered as a global pandemic since its first emergence in Wuhan,China.On March 12, 2020, the World Health Organization declared the COVID-19 outbreak a pandemic.There is no established system for the classification regarding COVID-19 related lymphopenia. four hypothetical mechanism regarding lymphopenia are : Direct infection of Lymphocyt, direct destroying of lymphocytic organs, inflamatory cytokins such as TNFɑ, IL-6,Lymphocyte inhibition,

Historical Perspective

  • Coronavirus disease 2019 (COVID-19) has been considered as a global pandemic since its first emergence in Wuhan,China.[1]
  • On March 12, 2020, the World Health Organization declared the COVID-19 outbreak a pandemic.
  • Since the first descriptive study lymphocyte count has been a marker of interest.[2]

Classification

There is no established system for the classification regarding COVID-19 related lymphopenia.

Causes

Differentiating COVID-19 related Lymphocytopenia from other Diseases

COVID-19 related Lymphocytopenia starts acutely in the course of the disease, with other manifestations of the disease.

Lymphocytopenia, is associated with corticosteroid use, infections with HIV and other viral, bacterial, and fungal agents, Hodgkin's disease, leukemia, malnutrition, systemic lupus erythematosus,[5] high stress levels, whole body radiation, rheumatoid arthritis, and iatrogenic conditions.

In alphabetical order. [6] [7]

Epidemiology and Demographics

  • The incidence of the Coronavirus Disease 2019 (COVID-19) as of June 28, 2020 is approximately 9,843,073 cases worldwide with 495,760 deaths.[8]
  • Patients of all age groups may develop COVID-19. However, the elderly population and immunocompromised individuals are more likely to develop severe cases of COVID-19.

Risk Factors

People of any age with certain underlying medical conditions are at increased risk for severe illness from COVID-19. These medical conditions include:[9]

Screening

  • Lymphopenia as a result of COVID-19 or any other acquired disease cannot be prevented.
  • A routine CBC with diffrential should be done in COVID-19 patients to detect and monitor the progression of lymphopenia.

Natural History, Complications, and Prognosis

Diagnosis

Diagnostic Choice of Study

Lymphopenia refers to a count of less than 1,000 lymphocytes per microliter of blood in adults, or less than 3,000 lymphocytes per microliter of blood in children.[11] The following tests are used to diagnose lymphopenia:

  • Complete Blood test
  • Flow cytometry

History and Symptoms

Lymphopenia as a result of COVID-19 can present with different symptoms. People with COVID-19 have had a wide range of symptoms reported – ranging from mild symptoms to severe illness. Symptoms may appear 2-14 days after exposure to the virus. People with these symptoms may have COVID-19:[12]

Lymphopenia as an indicator for severe disease

  • Lymphopenia is lymphocyte count of less than 1.5 × 109/L. It is associated with a 3-fold increased risk of severe COVID-19 infection.
  • Patients with lymphopenia on admission have been associated with poor prognostic outcomes[13]. Recent studies have shown that 85% of severely ill patients have lymphopenia. Futhermore, patients who have died from COVID-19 infection showed significantly lower lymphocyte level than survivors.[14]

References

  1. "WHO Western Pacific | World Health Organization".
  2. Ruan, Qiurong; Yang, Kun; Wang, Wenxia; Jiang, Lingyu; Song, Jianxin (2020). "Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China". Intensive Care Medicine. 46 (5): 846–848. doi:10.1007/s00134-020-05991-x. ISSN 0342-4642.
  3. Fischer, Karin; Hoffmann, Petra; Voelkl, Simon; Meidenbauer, Norbert; Ammer, Julia; Edinger, Matthias; Gottfried, Eva; Schwarz, Sabine; Rothe, Gregor; Hoves, Sabine; Renner, Kathrin; Timischl, Birgit; Mackensen, Andreas; Kunz-Schughart, Leoni; Andreesen, Reinhard; Krause, Stefan W.; Kreutz, Marina (2007). "Inhibitory effect of tumor cell–derived lactic acid on human T cells". Blood. 109 (9): 3812–3819. doi:10.1182/blood-2006-07-035972. ISSN 0006-4971.
  4. Liao, Yuan-Chun; Liang, Wei-Guang; Chen, Feng-Wei; Hsu, Ju-Hui; Yang, Jiann-Jou; Chang, Ming-Shi (2002). "IL-19 Induces Production of IL-6 and TNF-α and Results in Cell Apoptosis Through TNF-α". The Journal of Immunology. 169 (8): 4288–4297. doi:10.4049/jimmunol.169.8.4288. ISSN 0022-1767.
  5. W L Ng, C M Chu, A K L Wu, V C C Cheng, K Y Yuen. "Lymphopenia at presentation is associated with increased risk of infections in patients with systemic lupus erythematosus". Quarterly Journal of Medicine. 99 (1): 37–47. doi:10.1093/qjmed/hci155.
  6. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  7. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
  8. "WHO Coronavirus Disease (COVID-19) Dashboard | WHO Coronavirus Disease (COVID-19) Dashboard".
  9. "People Who Are at Higher Risk for Severe Illness | Coronavirus | COVID-19 | CDC".
  10. Zhao, Qianwen; Meng, Meng; Kumar, Rahul; Wu, Yinlian; Huang, Jiaofeng; Deng, Yunlei; Weng, Zhiyuan; Yang, Li (2020). "Lymphopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A systemic review and meta-analysis". International Journal of Infectious Diseases. 96: 131–135. doi:10.1016/j.ijid.2020.04.086. ISSN 1201-9712.
  11. "Lymphocytopenia | National Heart, Lung, and Blood Institute (NHLBI)".
  12. "Symptoms of Coronavirus | CDC".
  13. Huang, Ian; Pranata, Raymond (2020). "Lymphopenia in severe coronavirus disease-2019 (COVID-19): systematic review and meta-analysis". Journal of Intensive Care. 8 (1). doi:10.1186/s40560-020-00453-4. ISSN 2052-0492.
  14. Fathi, Nazanin; Rezaei, Nima (2020). "Lymphopenia in COVID‐19: Therapeutic opportunities". Cell Biology International. doi:10.1002/cbin.11403. ISSN 1065-6995.


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