Background: The coronavirus disease 2019 (COVID-19) is an aggressive virus that spread worldwide and caused a pandemic infection. It is a systemic disease involving multiple systems, including respiratory, cardiovascular, gastrointestinal, hematopoietic, neurological, and immune systems. White blood cells, hemoglobin, and platelets have a role in the development of signs and symptoms of coronavirus disease 2019.
Objectives: The present study aimed to investigate the haematological changes during Corona Virus infection among COVID-19 patients in the Sabratha region, Western Libya.
Subjects and Methods: Thirty Confirmed COVID-19 patients hospitalized in the Isolation Centre located in Sabratha city, Libya from the 2nd October, 2020 to the 15th March, 2021, were enrolled in this prospective study. Covid-19 patients were defined as positive cases after the detection of SARS-CoV-2 RNA in oro-nasopharyngeal swab samples. Data collected included demographic, clinical, and biological factors. Also, 30 healthy individuals without any chronic disease or respiratory symptoms were recruited for the control group. Blood samples were collected by vein puncture 5 ml of venous blood withdrawn from each participant in the study by using disposable syringes under an aseptic technique; they then transferred to a sterile EDTA tube, for complete blood count. Haematological parameters were determined using an automated haematology analyzer Sysmex (KX 21) machine in the Sabratha Isolation Centre laboratory. The statistical significance of differences between groups was evaluated with the Kruskal-Wallis H test. Correlations between the age and haematological parameters were evaluated with the Spearman’s test.
Results: The results showed that coronavirus infection caused a significant (P=0.0088) decrease in hemoglobin concentration, MCH (P=0.0008), MCHC (P< 0.0001), lymphocytes % (P< 0.0001), and mixed % (P=0.2496), and a significant increase in RDW-SD (P=0.0064), RDW-CV (P=0.0005), leukocytes count (P<0.0001), neutrophils % (P<0.0001), and neutrophils/lymphocytes ratio (P< 0.0001), and Platelets/Lymphocytes ratio (P< 0.0001) at 0 day, 14 days, and 21 days, respectively compared with the healthy individuals. The percentages of corona virus-infected patients with leukopenia were 3.3% at 0 day and 14 days of hospital admission, anemia was 26.7%, 16.7%, and 33.3%, leukocytosis was 60%, 56.7, and 50%, lymphocytopenia was 63.3%, 56.7%, and 43.3% and neutrophilia was 76.7%, 76.7%, and 60%, and with thrombocytopenia was 13.3%, 16.7%, and 10% at 0 day, 14 days, and 21 days of hospital admission, respectively. There were recorded a significant positive correlation between age of patients and WBCs count, Hb, Hct, MCV, RDW-SD, RDW-CV, PDW, and P-LCR, and a significant negative correlation with MXD%. Also, results showed that a significant positive correlation between WBCs count and Neutrophils %, RBCs count, Hb, Hct, RDW-SD, RDW-CV, PDW, and P-LCR, and a significant negative correlation with MXD%, Platelets count, and PCT. In addition, there was a significant positive correlation between lymphocytes % and MXD% and a significant negative correlation with Neutrophils %. There was a significant negative correlation between Neutrophils % and Lymphocytes % and MXD%. There was a significant negative correlation between MXD% and RBCs count, Hb, Hct, RDW-SD, RDW-CV, and PDW.
Conclusion: It can be concluded that coronavirus infection caused a significant decrease in hemoglobin, MCH, MCHC, lymphocytes %, mixed %, and a significant increase in RDW-SD, RDW-CV, leukocyte count, neutrophils %, and neutrophils/lymphocytes ratio in patients compared to the controls. There was a significant correlation between age, WBCs count, lymphocytes %, neutrophils %, MXD%, and some haematological parameters. The effects of coronavirus infection on hematological alterations are still poorly understood so, further haematological studies are needed to confirm these results. These haematological changes may help the clinicians to better understand the COVID-19 and provide more clinical treatment options.
Keywords: SARS-CoV-2, COVID-19, Coronavirus, Leukocytosis, Lymphocytopenia, Neutrophilia,Thrombocytopenia, Hematological parameters, Sabratha region, Western Libya.