Leukoerythroblastosis – An unsusal presentation of COVID 19 infection

OBJECTIVES: Although several peripheral blood abnormalities have been reported in COVID 19,Leukoerythroblastosis is an unusual finding. We report 33 COVID19 cases presenting with leukoerythroblastosis. We intend to describe its incidence in this novel viral infection and correlate it with the clinical outcome. METHODS: It is a Prospective study done at a Level 3 COVID 19 hospital of LUCKNOW, INDIA. Hematologic test records of day 1 of admission of COVID 19 cases admitted from 20th August 2020 to 30th September 2020 were reviewed. Peripheral blood smear examination was performed on test results that were flagged for abnormalities. Leukoerythroblastosis was reported when the smears showed presence of granulocyte left shift and nucleated red blood cells. Follow up smears were examined on Day 7. The findings were correlated with the clinical outcome. RESULTS: Out of 274 slides reviewed, 33 (12%) showed a leukoerythroblastic picture on day 1 of admission. Follow up smears on day 7 were available in 76% (25/33) cases. The follow up smears showed improvement in 13 cases, worsening in 9 cases and no changes in 3 cases. There were total 19 (58%) deaths. 12 patients (36%) recovered and 2 patients (6%) were shifted to other hospitals whose further follow up was not available. CONCLUSIONS: Leukoerythroblastosis is an unusual presentation of COVID 19. Although rare, this peripheral blood abnormality can provide insight into the underlying pathophysiologic processes. Furthermore, it seems to be an adverse prognostic factor, so examination of follow up smears may help clinicians and intensivists to make prompt management decisions.