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Atypical Peripheral Blood Cell Morphology in COVID-19 (Sars-CoV-2) Patients from Mount Sinai Health System in New York City

INTRODUCTION Coronavirus disease 2019 (COVID-19) is a respiratory disease caused by a novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Recent studies have suggested that COVID-19 positive patients present with leukopenia, lymphopenia, neutrophilia, thrombocytopen...

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Autores principales: Salib, Christian, Khattar, Pallavi, Cheng, Jinjun, Teruya-Feldstein, Julie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Society of Hematology 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8330324/
http://dx.doi.org/10.1182/blood-2020-142581
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author Salib, Christian
Khattar, Pallavi
Cheng, Jinjun
Teruya-Feldstein, Julie
author_facet Salib, Christian
Khattar, Pallavi
Cheng, Jinjun
Teruya-Feldstein, Julie
author_sort Salib, Christian
collection PubMed
description INTRODUCTION Coronavirus disease 2019 (COVID-19) is a respiratory disease caused by a novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Recent studies have suggested that COVID-19 positive patients present with leukopenia, lymphopenia, neutrophilia, thrombocytopenia, and higher neutrophil: lymphocyte ratio (NLR) and monocyte: lymphocyte ratio (MLR). More recently, we reported hypersegmented granulocytes and COVID-19 infection in Blood. 2020 Jun 11;135(24):2196. Neutrophil hypersegmentation has been closely associated with vitamin B12, folate and iron deficiencies, as well as methotrexate use, chemotherapy toxicity, uremia, heat stroke, myelodysplasia and Boucher-Neuhäuser Syndrome. Initially, these cytomorphologic changes may easily be overlooked or dismissed as non-specific reactive changes. In this study, we expand our initial observation on our index case to a larger case series. To the best of our knowledge, this is the largest case series to describe the concurrent lymphocyte and unique granulocyte atypia associated with SARS-CoV-2 infection. METHODS Study Design 2,199 patients were hospitalized in the Mount Sinai Health System from Feb 27 to April 2, 2020 with confirmed COVID-19 positivity. Data obtained for this study was covered under an Institutional Review Board (IRB) waiver, HS#:12-00133 GCO#1:12-036(0001-08) Inclusion criteria 50 peripheral blood smears flagged for Pathologist review from March 13 - April 20, 2020 at Mount Sinai Hospital Clinical Hematology Laboratory were included in this study. All suspected COVID-19 cases were confirmed using real-time polymerase chain reaction (RT-PCR) assay to test nasal and pharyngeal swab specimens, per WHO guidelines. Of the 50 COVID-19 positive peripheral blood smears, 39 slides were scanned and imaged with Scopio Labs X100 Full Field Digital Microscope. The X100 provided high resolution oil-immersion level images of large scanned areas. https://scopiolabs.com/hematology/ 19 peripheral blood smears were blindly and independently reviewed by 4 Hematopathologists (CS, PK, JC, JTF), with particular emphasis on granulocyte cytomorphology and percent of hypersegmented neutrophils present (defined as neutrophils with 5 or more nuclear lobes in at least 3% of cells or presence of 6 or more lobes). Atypical lymphocyte morphology was also evaluated and categorized as Downey type I, II, III or plasmacytoid, while monocyte morphology was assessed for unusual nuclear folds and features. Evaluation of platelets and other abnormalities were noted. The presence and degree of significant cytologic atypia was recorded and compared to 20 COVID-19 negative blood smears. RESULTS 16 of the 19 (84%) COVID-19 positive cases showed hypersegmented neutrophils, and all 19 harbored atypical lymphocytes and monocyte morphology, with giant platelets. In contrast, 5 of the 20 (25%) COVID-19 negative cases showed hypersegmented neutrophils, with 2 patients displaying atypical monocytes; none showed atypical lymphocytes or giant platelets (p = 0.022). Concurrent laboratory values showed no evidence of vitamin B12 or folate deficiency. Representative images are summarized in Figure 1 (A-C, 5-6 lobed neutrophils; D-E atypical plasmacytoid lymphocytes, G-I atypical monocytes, J-L giant platelets). CONCLUSION We report atypical hypersegmented neutrophils with toxic cytoplasmic change, atypical monocytes, plasmacytoid lymphocytes, and giant platelets in peripheral blood smears of COVID-19 patients which are significantly higher than in control COVID-19 negative patients. [Figure: see text] DISCLOSURES: Teruya-Feldstein:Edge Anthem: Consultancy.
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spelling pubmed-83303242021-08-03 Atypical Peripheral Blood Cell Morphology in COVID-19 (Sars-CoV-2) Patients from Mount Sinai Health System in New York City Salib, Christian Khattar, Pallavi Cheng, Jinjun Teruya-Feldstein, Julie Blood 203.Lymphocytes, Lymphocyte Activation, and Immunodeficiency, including HIV and Other Infections INTRODUCTION Coronavirus disease 2019 (COVID-19) is a respiratory disease caused by a novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Recent studies have suggested that COVID-19 positive patients present with leukopenia, lymphopenia, neutrophilia, thrombocytopenia, and higher neutrophil: lymphocyte ratio (NLR) and monocyte: lymphocyte ratio (MLR). More recently, we reported hypersegmented granulocytes and COVID-19 infection in Blood. 2020 Jun 11;135(24):2196. Neutrophil hypersegmentation has been closely associated with vitamin B12, folate and iron deficiencies, as well as methotrexate use, chemotherapy toxicity, uremia, heat stroke, myelodysplasia and Boucher-Neuhäuser Syndrome. Initially, these cytomorphologic changes may easily be overlooked or dismissed as non-specific reactive changes. In this study, we expand our initial observation on our index case to a larger case series. To the best of our knowledge, this is the largest case series to describe the concurrent lymphocyte and unique granulocyte atypia associated with SARS-CoV-2 infection. METHODS Study Design 2,199 patients were hospitalized in the Mount Sinai Health System from Feb 27 to April 2, 2020 with confirmed COVID-19 positivity. Data obtained for this study was covered under an Institutional Review Board (IRB) waiver, HS#:12-00133 GCO#1:12-036(0001-08) Inclusion criteria 50 peripheral blood smears flagged for Pathologist review from March 13 - April 20, 2020 at Mount Sinai Hospital Clinical Hematology Laboratory were included in this study. All suspected COVID-19 cases were confirmed using real-time polymerase chain reaction (RT-PCR) assay to test nasal and pharyngeal swab specimens, per WHO guidelines. Of the 50 COVID-19 positive peripheral blood smears, 39 slides were scanned and imaged with Scopio Labs X100 Full Field Digital Microscope. The X100 provided high resolution oil-immersion level images of large scanned areas. https://scopiolabs.com/hematology/ 19 peripheral blood smears were blindly and independently reviewed by 4 Hematopathologists (CS, PK, JC, JTF), with particular emphasis on granulocyte cytomorphology and percent of hypersegmented neutrophils present (defined as neutrophils with 5 or more nuclear lobes in at least 3% of cells or presence of 6 or more lobes). Atypical lymphocyte morphology was also evaluated and categorized as Downey type I, II, III or plasmacytoid, while monocyte morphology was assessed for unusual nuclear folds and features. Evaluation of platelets and other abnormalities were noted. The presence and degree of significant cytologic atypia was recorded and compared to 20 COVID-19 negative blood smears. RESULTS 16 of the 19 (84%) COVID-19 positive cases showed hypersegmented neutrophils, and all 19 harbored atypical lymphocytes and monocyte morphology, with giant platelets. In contrast, 5 of the 20 (25%) COVID-19 negative cases showed hypersegmented neutrophils, with 2 patients displaying atypical monocytes; none showed atypical lymphocytes or giant platelets (p = 0.022). Concurrent laboratory values showed no evidence of vitamin B12 or folate deficiency. Representative images are summarized in Figure 1 (A-C, 5-6 lobed neutrophils; D-E atypical plasmacytoid lymphocytes, G-I atypical monocytes, J-L giant platelets). CONCLUSION We report atypical hypersegmented neutrophils with toxic cytoplasmic change, atypical monocytes, plasmacytoid lymphocytes, and giant platelets in peripheral blood smears of COVID-19 patients which are significantly higher than in control COVID-19 negative patients. [Figure: see text] DISCLOSURES: Teruya-Feldstein:Edge Anthem: Consultancy. American Society of Hematology 2020-11-05 2021-08-03 /pmc/articles/PMC8330324/ http://dx.doi.org/10.1182/blood-2020-142581 Text en Copyright © 2020 American Society of Hematology. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle 203.Lymphocytes, Lymphocyte Activation, and Immunodeficiency, including HIV and Other Infections
Salib, Christian
Khattar, Pallavi
Cheng, Jinjun
Teruya-Feldstein, Julie
Atypical Peripheral Blood Cell Morphology in COVID-19 (Sars-CoV-2) Patients from Mount Sinai Health System in New York City
title Atypical Peripheral Blood Cell Morphology in COVID-19 (Sars-CoV-2) Patients from Mount Sinai Health System in New York City
title_full Atypical Peripheral Blood Cell Morphology in COVID-19 (Sars-CoV-2) Patients from Mount Sinai Health System in New York City
title_fullStr Atypical Peripheral Blood Cell Morphology in COVID-19 (Sars-CoV-2) Patients from Mount Sinai Health System in New York City
title_full_unstemmed Atypical Peripheral Blood Cell Morphology in COVID-19 (Sars-CoV-2) Patients from Mount Sinai Health System in New York City
title_short Atypical Peripheral Blood Cell Morphology in COVID-19 (Sars-CoV-2) Patients from Mount Sinai Health System in New York City
title_sort atypical peripheral blood cell morphology in covid-19 (sars-cov-2) patients from mount sinai health system in new york city
topic 203.Lymphocytes, Lymphocyte Activation, and Immunodeficiency, including HIV and Other Infections
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8330324/
http://dx.doi.org/10.1182/blood-2020-142581
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