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Harte JV, Coleman-Vaughan C, Crowley MP, Mykytiv V. It's in the blood: a review of the hematological system in SARS-CoV-2-associated COVID-19. Crit Rev Clin Lab Sci 2023; 60:595-624. [PMID: 37439130 DOI: 10.1080/10408363.2023.2232010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/27/2023] [Indexed: 07/14/2023]
Abstract
The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to an unprecedented global healthcare crisis. While SARS-CoV-2-associated COVID-19 affects primarily the respiratory system, patients with COVID-19 frequently develop extrapulmonary manifestations. Notably, changes in the hematological system, including lymphocytopenia, neutrophilia and significant abnormalities of hemostatic markers, were observed early in the pandemic. Hematological manifestations have since been recognized as important parameters in the pathophysiology of SARS-CoV-2 and in the management of patients with COVID-19. In this narrative review, we summarize the state-of-the-art regarding the hematological and hemostatic abnormalities observed in patients with SARS-CoV-2-associated COVID-19, as well as the current understanding of the hematological system in the pathophysiology of acute and chronic SARS-CoV-2-associated COVID-19.
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Affiliation(s)
- James V Harte
- Department of Haematology, Cork University Hospital, Wilton, Cork, Ireland
- School of Biochemistry & Cell Biology, University College Cork, Cork, Ireland
| | | | - Maeve P Crowley
- Department of Haematology, Cork University Hospital, Wilton, Cork, Ireland
- Irish Network for Venous Thromboembolism Research (INViTE), Ireland
| | - Vitaliy Mykytiv
- Department of Haematology, Cork University Hospital, Wilton, Cork, Ireland
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2
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Ormen M, Doruk OG, Gozgoz H, Kutlu A, Nurcan G, Sevinc C, Appak O, Kutsoylu OE, Bayraktar F, Yanturali S, Tuncel P. Leucocyte volume, conductivity, and scatter at presentation in COVID-19 patients. Niger J Clin Pract 2023; 26:771-778. [PMID: 37470652 DOI: 10.4103/njcp.njcp_737_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Background In COVID-19 patients, besides changes in leucocyte count, morphological abnormalities of circulating blood cells have been reported. Aim This study aims to investigate the relationship between the morphological and functional properties of leucocytes and the severity of the disease in COVID-19 patients. Materials and Methods Blood samples were collected from COVID-19 patients (n = 130) at the time of admission. The patients were stratified according to the comorbidity, age, LDH, lymhocyte count score as mild, moderate, and severe. Complete blood count and the cell population data were analyzed by the Volume, conductivity, scatter (VCS) technology on Beckman Coulter LH-780 hematology analyzer. Kruskal-Wal'lis test was used to assess the differences between the groups with subsequent Bonferroni correction. Results Neutrophil count was increased, and lymphocyte count was decreased in severe patients compared to mild patients. The increase in the percent of neutrophils and the neutrophil/lymphocyte ratio in the severe patient group was significant in comparison to both the moderate and the mild group. The dispersion of the neutrophil volume and conductivity showed significant changes depending on the severity of the disease. The lymphocyte volume, lymphocyte-volume-SD and lymphocyte-conductivity as well as the monocyte-volume and monocyte-volume-SD were significantly increased in severe patients in comparison to mild patients. The increase of lymphocyte and monocyte volume in severe patients was also significant in comparison to moderate patients. Conclusions COVID-19 infection leads to important changes in cell population data of leucocytes. The volumetric changes in lymphocytes and monocytes are related to the severity of the disease.
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Affiliation(s)
- M Ormen
- Department of Medical Biochemistry, Dokuz Eylül University Faculty of Medicine, Turkey
| | - O G Doruk
- Department of Medical Biochemistry, Dokuz Eylül University Faculty of Medicine, Turkey
| | - H Gozgoz
- Department of Medical Biochemistry, Dokuz Eylül University Faculty of Medicine, Turkey
| | - A Kutlu
- Department of Medical Biochemistry, Dokuz Eylül University Faculty of Medicine, Turkey
| | - G Nurcan
- Department of Chest Diseases, Dokuz Eylül University Faculty of Medicine, Turkey
| | - C Sevinc
- Department of Chest Diseases, Dokuz Eylül University Faculty of Medicine, Turkey
| | - O Appak
- Department of Medical Microbiology, Dokuz Eylül University Faculty of Medicine, Turkey
| | - O E Kutsoylu
- Department of Infectious Diseases and Clinical Microbiology, Dokuz Eylül University Faculty of Medicine, Turkey
| | - F Bayraktar
- Department of Internal Diseases, Dokuz Eylül University Faculty of Medicine, Turkey
| | - S Yanturali
- Department of Emergency Medicine, Dokuz Eylül University Faculty of Medicine, Turkey
| | - P Tuncel
- Department of Medical Biochemistry, Dokuz Eylül University Faculty of Medicine, Turkey
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3
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Immune Dynamics Involved in Acute and Convalescent COVID-19 Patients. IMMUNO 2023. [DOI: 10.3390/immuno3010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
Abstract
COVID-19 is a viral disease that has caused millions of deaths around the world since 2020. Many strategies have been developed to manage patients in critical conditions; however, comprehension of the immune system is a key factor in viral clearance, tissue repairment, and adaptive immunity stimulus. Participation of immunity has been identified as a major factor, along with biomarkers, prediction of clinical outcomes, and antibody production after infection. Immune cells have been proposed not only as a hallmark of severity, but also as a predictor of clinical outcomes, while dynamics of inflammatory molecules can also induce worse consequences for acute patients. For convalescent patients, mild disease was related to higher antibody production, although the factors related to the specific antibodies based on a diversity of antigens were not clear. COVID-19 was explored over time; however, the study of immunological predictors of outcomes is still lacking discussion, especially in convalescent patients. Here, we propose a review using previously published studies to identify immunological markers of COVID-19 outcomes and their relation to antibody production to further contribute to the clinical and laboratorial management of patients.
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4
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Schoenmakers T, van Bussel BCT, Gorissen SHM, van Loo IHM, van Rosmalen F, Verboeket-van de Venne WPHG, Wolffs PFG, van Mook WNKA, Leers MPG. Validating a clinical laboratory parameter-based deisolation algorithm for patients with COVID-19 in the intensive care unit using viability PCR: the CoLaIC multicentre cohort study protocol. BMJ Open 2023; 13:e069455. [PMID: 36854586 PMCID: PMC9979582 DOI: 10.1136/bmjopen-2022-069455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
INTRODUCTION To investigate whether biochemical and haematological changes due to the patient's host response (CoLab algorithm) in combination with a SARS-CoV-2 viability PCR (v-PCR) can be used to determine when a patient with COVID-19 is no longer infectious.We hypothesise that the CoLab algorithm in combination with v-PCR can be used to determine whether or not a patient with COVID-19 is infectious to facilitate the safe release of patients with COVID-19 from isolation. METHODS AND ANALYSIS This study consists of three parts using three different cohorts of patients. All three cohorts contain clinical, vital and laboratory parameters, as well as logistic data related to isolated patients with COVID-19, with a focus on intensive care unit (ICU) stay. The first cohort will be used to develop an algorithm for the course of the biochemical and haematological changes of the host response of the COVID-19 patient. Simultaneously, a second prospective cohort will be used to investigate the algorithm derived in the first cohort, with daily measured laboratory parameters, next to conventional SARS-CoV-2 reverse transcriptase PCRs, as well as v-PCR, to confirm the presence of intact SARS-CoV-2 particles in the patient. Finally, a third multicentre cohort, consisting of retrospectively collected data from patients with COVID-19 admitted to the ICU, will be used to validate the algorithm. ETHICS AND DISSEMINATION This study was approved by the Medical Ethics Committee from Maastricht University Medical Centre+ (cohort I: 2020-1565/300523) and Zuyderland MC (cohorts II and III: METCZ20200057). All patients will be required to provide informed consent. Results from this study will be disseminated via peer-reviewed journals and congress/consortium presentations.
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Affiliation(s)
- Tom Schoenmakers
- Department of Clinical Chemistry and Hematology, Zuyderland Medical Centre, Sittard-Geleen/Heerlen, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Bas C T van Bussel
- Department of Intensive Care, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Stefan H M Gorissen
- Zuyderland Academy, Zuyderland Medical Centre, Sittard-Geleen/Heerlen, The Netherlands
| | - Inge H M van Loo
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Medical Microbiology, Infectious Diseases & Infection Prevention, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Frank van Rosmalen
- Department of Intensive Care, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | | | - Petra F G Wolffs
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Medical Microbiology, Infectious Diseases & Infection Prevention, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Walter N K A van Mook
- Department of Intensive Care, Maastricht University Medical Centre+, Maastricht, The Netherlands
- School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
| | - Mathie P G Leers
- Department of Clinical Chemistry and Hematology, Zuyderland Medical Centre, Sittard-Geleen/Heerlen, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
- Department of Intensive Care, Maastricht University Medical Centre+, Maastricht, The Netherlands
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5
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Harte JV, Ní Choileáin C, Grieve C, Hooton C, Mykytiv V. A panhaemocytometric approach to COVID-19: the importance of cell population data on Sysmex XN-series analysers in severe disease. Clin Chem Lab Med 2023; 61:e43-e47. [PMID: 36514925 DOI: 10.1515/cclm-2022-1066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 11/17/2022] [Indexed: 12/15/2022]
Affiliation(s)
- James V Harte
- Haematology Department, Cork University Hospital, Cork, Ireland
| | | | - Conor Grieve
- Haematology Department, Cork University Hospital, Cork, Ireland
| | - Carmel Hooton
- Microbiology Department, Cork University Hosipital, Cork, Ireland
| | - Vitaliy Mykytiv
- Haematology Department, Cork University Hospital, Cork, Ireland
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6
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Hoffmann JJML. Cell population data: much more to explore. Clin Chem Lab Med 2023; 61:377-379. [PMID: 36622868 DOI: 10.1515/cclm-2022-1173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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7
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Aguirre U, Urrechaga E. Diagnostic performance of machine learning models using cell population data for the detection of sepsis: a comparative study. Clin Chem Lab Med 2023; 61:356-365. [PMID: 36351434 DOI: 10.1515/cclm-2022-0713] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 10/18/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To compare the artificial intelligence algorithms as powerful machine learning methods for evaluating patients with suspected sepsis using data from routinely available blood tests performed on arrival at the hospital. Results were compared with those obtained from the classical logistic regression method. METHODS The study group consisted of consecutive patients with fever and suspected infection admitted to the Emergency Department. The complete blood counts (CBC) were acquired using the Mindray BC-6800 Plus analyser (Mindray Diagnostics, Shenzhen, China). Cell Population Data (CPD) were also recorded. The ML and artificial intelligence (AI) models were developed; their performance was evaluated using several indicators, such as the area under the receiver operating curve (AUC), calibration plots and decision curve analysis (DCA). RESULTS Overall, all the tested approaches obtained an AUC>0.90. The logistic regression (LR) performed well compared to the ML/AI models. The naïve Bayes and the K-nearest neighbour (KNN) methods did not show good calibration properties. The multi-layer perceptron (MLP) model was the best in terms of discrimination, calibration and clinical usefulness. CONCLUSIONS The best performance in the early detection of sepsis was achieved using the ML and AI models. However, external validation studies are needed to strengthen model derivation and procedure updating.
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Affiliation(s)
- Urko Aguirre
- Research Unit, Osakidetza Basque Health Service, Barrualde-Galdakao Integrated Health Organisation, Galdakao-Usansolo Hospital, Galdakao, Spain
- Kronikgune Institute for Health Services Research, Barakaldo, Spain
- Research Network in Health Services in Chronic Diseases (Red de Investigación en Servicios de Salud en Enfermedades Crónicas, REDISSEC), Galdakao, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Galdakao, Spain
| | - Eloísa Urrechaga
- CORE Laboratory, Hospital Galdakao-Usansolo, Galdakao, Vizcaya, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Vizcaya, Spain
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8
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Hoffmann JJML, Urrechaga E. Recent advances in laboratory hematology reflected by a decade of CCLM publications. Clin Chem Lab Med 2022; 61:829-840. [PMID: 36285728 DOI: 10.1515/cclm-2022-0962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/15/2022]
Abstract
Abstract
On the occasion of the 60th anniversary of Clinical Chemistry and Laboratory Medicine (CCLM) we present a review of recent developments in the discipline of laboratory hematology as these are reflected by papers published in CCLM in the period 2012–2022. Since data on CCLM publications from 1963 to 2012 are also available, we were able to make a comparison between the two periods. This interestingly revealed that the share of laboratory hematology papers has steadily increased and reached now 16% of all papers published in CCLM. It also became evident that blood coagulation and fibrinolysis, erythrocytes, platelets and instrument and method evaluation constituted the ‘hottest’ topics with regard to number of publications. Some traditional, characteristic CCLM categories like reference intervals, standardization and harmonization, were more stable and probably will remain so in the future. With the advent of important newer topics, like new coagulation assays and drugs and cell population data generated by hematology analyzers, laboratory hematology is anticipated to remain a significant discipline in CCLM publications.
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Affiliation(s)
| | - Eloísa Urrechaga
- Biocruces Bizkaia Health Research Institute , Baracaldo , Spain
- Core Laboratory, Hospital Galdakao Usansolo , Vizcaya , Spain
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9
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Azghar A, Bensalah M, Berhili A, Slaoui M, Mouhoub B, El Mezgueldi I, Nassiri O, El Malki J, Maleb A, Seddik R. Value of hematological parameters for predicting patients with severe coronavirus disease 2019: a real-world cohort from Morocco. J Int Med Res 2022; 50:3000605221109381. [PMID: 35854474 PMCID: PMC9340338 DOI: 10.1177/03000605221109381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective Coronavirus disease 2019 (COVID-19) is a viral disease caused by severe acute
respiratory syndrome coronavirus 2. The clinical manifestations and the
evolution of patients with COVID-19 are variable. In addition to respiratory
involvement, COVID-19 leads to systemic involvement and can affect the
hematopoietic system. This study aimed to evaluate the prognostic value of
hematological and hemocytometric parameters in predicting the severity of
patients with COVID-19. Methods We performed a retrospective study at Mohammed VI university Hospital from 1
March to 11 November 2020. We collected demographic characteristics and
hematological findings of incident COVID-19 cases. Results A total of 245 patients were included in our study. We found that the rate of
lymphopenia was significantly reduced in patients who were severely affected
by COVID-19. Additionally, the rate of neutrophilia, the neutrophil side
fluorescence light signal, monocyte fluorescent intensity, monocyte size,
the neutrophil-to-lymphocyte ratio, the platelet-to-lymphocyte ratio, and
the lymphocyte-to-monocyte ratio were significantly elevated in patients who
were severely affected by COVID-19. Conclusions These results are consistent with the literature regarding the predictive
value of these markers. A prospective validation in a large population with
a longer follow-up is required.
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Affiliation(s)
- Ali Azghar
- Hematology Laboratory, Mohammed VI University Hospital Center, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Mohammed 1st University, Oujda, Morocco
| | - Mohammed Bensalah
- Hematology Laboratory, Mohammed VI University Hospital Center, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Mohammed 1st University, Oujda, Morocco
| | - Abdelilah Berhili
- Hematology Laboratory, Mohammed VI University Hospital Center, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Mohammed 1st University, Oujda, Morocco
| | - Mounia Slaoui
- Hematology Laboratory, Mohammed VI University Hospital Center, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Mohammed 1st University, Oujda, Morocco
| | - Boutaina Mouhoub
- Hematology Laboratory, Mohammed VI University Hospital Center, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Mohammed 1st University, Oujda, Morocco
| | - Imane El Mezgueldi
- Hematology Laboratory, Mohammed VI University Hospital Center, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Mohammed 1st University, Oujda, Morocco
| | - Oumaima Nassiri
- Hematology Laboratory, Mohammed VI University Hospital Center, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Mohammed 1st University, Oujda, Morocco
| | - Jalila El Malki
- Hematology Laboratory, Mohammed VI University Hospital Center, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Mohammed 1st University, Oujda, Morocco
| | - Adil Maleb
- Microbiology Laboratory, Mohammed VI University Hospital Center, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Mohammed 1st University, Oujda, Morocco
| | - Rachid Seddik
- Hematology Laboratory, Mohammed VI University Hospital Center, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Mohammed 1st University, Oujda, Morocco
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10
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Use of an algorithm based on routine blood laboratory tests to exclude COVID-19 in a screening-setting of healthcare workers. PLoS One 2022; 17:e0270548. [PMID: 35763522 PMCID: PMC9239486 DOI: 10.1371/journal.pone.0270548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/13/2022] [Indexed: 11/19/2022] Open
Abstract
Background COVID-19 is an ongoing pandemic leading to exhaustion of the hospital care system. Our health care system has to deal with a high level of sick leave of health care workers (HCWs) with COVID-19 related complaints, in whom an infection with SARS-CoV-2 has to be ruled out before they can return back to work. The aim of the present study is to investigate if the recently described CoLab-algorithm can be used to exclude COVID-19 in a screening setting of HCWs. Methods In the period from January 2021 till March 2021, HCWs with COVID-19-related complaints were prospectively collected and included in this study. Next to the routinely performed SARS-CoV-2 RT-PCR, using a set of naso- and oropharyngeal swab samples, two blood tubes (one EDTA- and one heparin-tube) were drawn for analysing the 10 laboratory parameters required for running the CoLab-algorithm. Results In total, 726 HCWs with a complete CoLab-laboratory panel were included in this study. In this group, 684 HCWs were tested SARS-CoV-2 RT-PCR negative and 42 cases RT-PCR positive. ROC curve analysis showed an area under the curve (AUC) of 0.853 (95% CI: 0.801–0.904). At a safe cut-off value for excluding COVID-19 of -6.525, the sensitivity was 100% with a specificity of 34% (95% CI: 21 to 49%). No SARS-CoV-2 RT-PCR cases were missed with this cut-off and COVID-19 could be safely ruled out in more than one third of HCWs. Conclusion The CoLab-score is an easy and reliable algorithm that can be used for screening HCWs with COVID-19 related complaints. A major advantage of this approach is that the results of the score are available within 1 hour after collecting the samples. This results in a faster return to labour process of a large part of the COVID-19 negative HCWs (34%), next to a reduction in RT-PCR tests (reagents and labour costs) that can be saved.
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11
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Urrechaga E, Ponga C, Fernández M, España PP, Haider RZ, Aguirre U. Diagnostic potential of leukocyte differential and cell population data in prediction of COVID-19 among related viral and bacterial infections at Emergency Department. Clin Chem Lab Med 2022; 60:e104-e107. [PMID: 35112524 DOI: 10.1515/cclm-2021-1309] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/24/2022] [Indexed: 12/20/2022]
Affiliation(s)
- Eloísa Urrechaga
- Biocruces Bizkaia Health Research Institute, Baracaldo, Spain
- Laboratory, Hospital Galdakao, Usansolo, Galdakao, Spain
| | - Cristina Ponga
- Laboratory, Hospital Galdakao, Usansolo, Galdakao, Spain
| | | | - Pedro Pablo España
- Biocruces Bizkaia Health Research Institute, Baracaldo, Spain
- Department of Pneumology, Hospital Galdakao, Usansolo, Galdakao, Spain
| | - Rana Zeeshan Haider
- Baqai Institute of Hematology, Baqai Medical University, Karachi, Pakistan
- National Institute of Blood Disease (NIBD), Karachi, Pakistan
| | - Urko Aguirre
- Research Unit, OSI-Barrualde-Galdakao, Galdakao, Spain
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12
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Birindelli S, Tarkowski MS, Gallucci M, Schiuma M, Covizzi A, Lewkowicz P, Aloisio E, Falvella FS, Dolci A, Riva A, Galli M, Panteghini M. Definition of the Immune Parameters Related to COVID-19 Severity. Front Immunol 2022; 13:850846. [PMID: 35371011 PMCID: PMC8971756 DOI: 10.3389/fimmu.2022.850846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 02/23/2022] [Indexed: 01/08/2023] Open
Abstract
A relevant portion of patients with disease caused by the severe acute respiratory syndrome coronavirus 2 (COVID-19) experience negative outcome, and several laboratory tests have been proposed to predict disease severity. Among others, dramatic changes in peripheral blood cells have been described. We developed and validated a laboratory score solely based on blood cell parameters to predict survival in hospitalized COVID-19 patients. We retrospectively analyzed 1,619 blood cell count from 226 consecutively hospitalized COVID-19 patients to select parameters for inclusion in a laboratory score predicting severity of disease and survival. The score was derived from lymphocyte- and granulocyte-associated parameters and validated on a separate cohort of 140 consecutive COVID-19 patients. Using ROC curve analysis, a best cutoff for score of 30.6 was derived, which was associated to an overall 82.0% sensitivity (95% CI: 78–84) and 82.5% specificity (95% CI: 80–84) for detecting outcome. The scoring trend effectively separated survivor and non-survivor groups, starting 2 weeks before the end of the hospitalization period. Patients’ score time points were also classified into mild, moderate, severe, and critical according to the symptomatic oxygen therapy administered. Fluctuations of the score should be recorded to highlight a favorable or unfortunate trend of the disease. The predictive score was found to reflect and anticipate the disease gravity, defined by the type of the oxygen support used, giving a proof of its clinical relevance. It offers a fast and reliable tool for supporting clinical decisions and, most important, triage in terms of not only prioritization but also allocation of limited medical resources, especially in the period when therapies are still symptomatic and many are under development. In fact, a prolonged and progressive increase of the score can suggest impaired chances of survival and/or an urgent need for intensive care unit admission.
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Affiliation(s)
- Sarah Birindelli
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
- *Correspondence: Sarah Birindelli,
| | - Maciej S. Tarkowski
- Department of Biomedical and Clinical Sciences, “Luigi Sacco”, University of Milan, Milan, Italy
| | - Marcello Gallucci
- Department of Psychology, University of Milano Bicocca, Milan, Italy
| | - Marco Schiuma
- Department of Infectious Diseases, Division III, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Alice Covizzi
- Department of Infectious Diseases, Division III, ASST Fatebenefratelli-Sacco, Milan, Italy
| | | | - Elena Aloisio
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | | | - Alberto Dolci
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
- Department of Biomedical and Clinical Sciences, “Luigi Sacco”, University of Milan, Milan, Italy
| | - Agostino Riva
- Department of Biomedical and Clinical Sciences, “Luigi Sacco”, University of Milan, Milan, Italy
- Department of Infectious Diseases, Division III, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Massimo Galli
- Department of Biomedical and Clinical Sciences, “Luigi Sacco”, University of Milan, Milan, Italy
- Department of Infectious Diseases, Division III, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Mauro Panteghini
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
- Department of Biomedical and Clinical Sciences, “Luigi Sacco”, University of Milan, Milan, Italy
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13
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Al-Saadi EAKD, Abdulnabi MA. Hematological changes associated with COVID-19 infection. J Clin Lab Anal 2022; 36:e24064. [PMID: 34783405 PMCID: PMC8646489 DOI: 10.1002/jcla.24064] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 09/02/2021] [Accepted: 09/09/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The unresolved COVID-19 pandemic considerably impacts the health services in Iraq and worldwide. Consecutive waves of mutated virus increased virus spread and further constrained health systems. Although molecular identification of the virus by polymerase chain reaction is the only recommended method in diagnosing COVID-19 infection, radiological, biochemical, and hematological studies are substantially important in risk stratification, patient follow-up, and outcome prediction. AIM This narrative review summarized the hematological changes including the blood indices, coagulative indicators, and other associated biochemical laboratory markers in different stages of COVID-19 infection, highlighting the diagnostic and prognostic significance. METHODS Literature search was conducted for multiple combinations of different hematological tests and manifestations with novel COVID-19 using the following key words: "hematological," "complete blood count," "lymphopenia," "blood indices," "markers" "platelet" OR "thrombocytopenia" AND "COVID-19," "coronavirus2019," "2019-nCoV," OR "SARS-CoV-2." Articles written in the English language and conducted on human samples between December 2019 and January 2021 were included. RESULTS Hematological changes are not reported in asymptomatic or presymptomatic COVID-19 patients. In nonsevere cases, hematological changes are subtle, included mainly lymphocytopenia (80.4%). In severe, critically ill patients and those with cytokine storm, neutrophilia, lymphocytopenia, elevated D-dimer, prolonged PT, and reduced fibrinogen are predictors of disease progression and adverse outcome. CONCLUSION Monitoring hematological changes in patients with COVID-19 can predict patients needing additional care and stratify the risk for severe course of the disease. More studies are required in Iraq to reflect the hematological changes in COVID-19 as compared to global data.
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Affiliation(s)
| | - Marwa Ali Abdulnabi
- Department of pathology, Al-Kindy College of Medicine University of Baghdad, Baghdad, Iraq
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Garrafa E, Vezzoli M, Ravanelli M, Farina D, Borghesi A, Calza S, Maroldi R. Early prediction of in-hospital death of COVID-19 patients: a machine-learning model based on age, blood analyses, and chest x-ray score. eLife 2021; 10:70640. [PMID: 34661530 PMCID: PMC8550757 DOI: 10.7554/elife.70640] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/17/2021] [Indexed: 12/15/2022] Open
Abstract
An early-warning model to predict in-hospital mortality on admission of COVID-19 patients at an emergency department (ED) was developed and validated using a machine-learning model. In total, 2782 patients were enrolled between March 2020 and December 2020, including 2106 patients (first wave) and 676 patients (second wave) in the COVID-19 outbreak in Italy. The first-wave patients were divided into two groups with 1474 patients used to train the model, and 632 to validate it. The 676 patients in the second wave were used to test the model. Age, 17 blood analytes, and Brescia chest X-ray score were the variables processed using a random forests classification algorithm to build and validate the model. Receiver operating characteristic (ROC) analysis was used to assess the model performances. A web-based death-risk calculator was implemented and integrated within the Laboratory Information System of the hospital. The final score was constructed by age (the most powerful predictor), blood analytes (the strongest predictors were lactate dehydrogenase, D-dimer, neutrophil/lymphocyte ratio, C-reactive protein, lymphocyte %, ferritin std, and monocyte %), and Brescia chest X-ray score (https://bdbiomed.shinyapps.io/covid19score/). The areas under the ROC curve obtained for the three groups (training, validating, and testing) were 0.98, 0.83, and 0.78, respectively. The model predicts in-hospital mortality on the basis of data that can be obtained in a short time, directly at the ED on admission. It functions as a web-based calculator, providing a risk score which is easy to interpret. It can be used in the triage process to support the decision on patient allocation.
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Affiliation(s)
- Emirena Garrafa
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.,ASST Spedali Civili di Brescia, Department of Laboratory, Brescia, Italy
| | - Marika Vezzoli
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Marco Ravanelli
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.,ASST Spedali Civili di Brescia, Department of Radiology, Brescia, Italy
| | - Davide Farina
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.,ASST Spedali Civili di Brescia, Department of Radiology, Brescia, Italy
| | - Andrea Borghesi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.,ASST Spedali Civili di Brescia, Department of Radiology, Brescia, Italy
| | - Stefano Calza
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Roberto Maroldi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.,ASST Spedali Civili di Brescia, Department of Radiology, Brescia, Italy
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15
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Myari A, Papapetrou E, Tsaousi C. Diagnostic value of white blood cell parameters for COVID-19: Is there a role for HFLC and IG? Int J Lab Hematol 2021; 44:104-111. [PMID: 34623763 PMCID: PMC8653118 DOI: 10.1111/ijlh.13728] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 09/02/2021] [Accepted: 09/20/2021] [Indexed: 12/13/2022]
Abstract
Introduction As the Coronavirus disease 2019 (COVID‐19) pandemic is still ongoing with patients overwhelming healthcare facilities, we aimed to investigate the ability of white blood cell count (WBC) and their subsets, high fluorescence lymphocyte cells (HFLC), immature granulocyte count (IG), and C‐reactive protein (CRP) to aid diagnosis of COVID‐19 during the triage process and as indicators of disease progression to serious and critical condition. Methods We collected clinical and laboratory data of patients, suspected COVID‐19 cases, admitted at the emergency department of University General Hospital of Ioannina (Ioannina, Greece). We selected 197 negative and 368 positive cases, confirmed by polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2. COVID‐19 cases were classified into mild, serious, and critical disease. Receiver operating characteristic curve and binary logistic regression analysis were utilized for assessing the diagnosing ability of biomarkers. Results WBC, neutrophil count (NEUT), and HFLC can discriminate efficiently negative cases from mild and serious COVID‐19, whereas eosinopenia and basopenia are early indicators of the disease. The combined WBC‐HFLC marker is the best diagnostic marker for both mild (sensitivity: 90.6% and specificity: 64.1%) and serious (sensitivity: 90.3% and specificity: 73.4%) disease. CRP and Lymphocyte count are early indicators of progression to serious disease whereas WBC, NEUT, IG, and neutrophil‐to‐lymphocyte ratio are the best indicators of critical disease. Conclusion Lymphopenia is not useful in screening patients with COVID‐19. HFLC is a good diagnostic marker for mild and serious disease either as a single marker or combined with WBC whereas IG is a good indicator of progression to critical disease.
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Affiliation(s)
- Alexandra Myari
- Hematology Lab, University General Hospital of Ioannina, Ioannina, Greece
| | | | - Christina Tsaousi
- Hematology Lab, University General Hospital of Ioannina, Ioannina, Greece
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16
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Kwiecień I, Rutkowska E, Kulik K, Kłos K, Plewka K, Raniszewska A, Rzepecki P, Chciałowski A. Neutrophil Maturation, Reactivity and Granularity Research Parameters to Characterize and Differentiate Convalescent Patients from Active SARS-CoV-2 Infection. Cells 2021; 10:cells10092332. [PMID: 34571981 PMCID: PMC8472477 DOI: 10.3390/cells10092332] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/25/2021] [Accepted: 09/03/2021] [Indexed: 01/08/2023] Open
Abstract
Studying the dynamics changes of neutrophils during innate immune response in coronavirus 2019 (COVID-19) can help understand the pathogenesis of this disease. The aim of the study was to assess the usefulness of new neutrophil activation parameters: Immature Granulocyte (IG), Neutrophil Reactivity Intensity (NEUT-RI), Neutrophil Granularity Intensity (NEUT-GI), and data relating to granularity, activity, and neutrophil volume (NE-WX, NE-WY, NE-WZ) available in hematology analyzers to distinguish convalescent patients from patients with active SARS-CoV-2 infection and healthy controls (HC). The study group consisted of 79 patients with a confirmed positive RT-PCR test for SARS-CoV2 infection, 71 convalescent patients, and 20 HC. We observed leukopenia with neutrophilia in patients with active infection compared to convalescents and HC. The IG median absolute count was higher in convalescent patients than in COVID-19 and HC (respectively, 0.08 vs. 0.03 vs. 0.02, p < 0.0001). The value of the NEUT-RI parameter was the highest in HC and the lowest in convalescents (48.3 vs. 43.7, p < 0.0001). We observed the highest proportion of NE-WX, NE-WY, and NE-WZ parameters in HC, without differences between the COVID-19 and convalescent groups. New neutrophil parameters can be useful tools to assess neutrophils’ activity and functionalities in the immune response during infection and recovery from COVID-19 disease.
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Affiliation(s)
- Iwona Kwiecień
- Laboratory of Hematology and Flow Cytometry, Department of Internal Medicine and Hematology, Military Institute of Medicine, Szaserów 128, 04-141 Warsaw, Poland; (E.R.); (K.K.); (A.R.)
- Correspondence:
| | - Elżbieta Rutkowska
- Laboratory of Hematology and Flow Cytometry, Department of Internal Medicine and Hematology, Military Institute of Medicine, Szaserów 128, 04-141 Warsaw, Poland; (E.R.); (K.K.); (A.R.)
| | - Katarzyna Kulik
- Laboratory of Hematology and Flow Cytometry, Department of Internal Medicine and Hematology, Military Institute of Medicine, Szaserów 128, 04-141 Warsaw, Poland; (E.R.); (K.K.); (A.R.)
| | - Krzysztof Kłos
- Department of Infectious Diseases and Allergology, Military Institute of Medicine, Szaserów 128, 04-141 Warsaw, Poland; (K.K.); (K.P.); (A.C.)
| | - Katarzyna Plewka
- Department of Infectious Diseases and Allergology, Military Institute of Medicine, Szaserów 128, 04-141 Warsaw, Poland; (K.K.); (K.P.); (A.C.)
| | - Agata Raniszewska
- Laboratory of Hematology and Flow Cytometry, Department of Internal Medicine and Hematology, Military Institute of Medicine, Szaserów 128, 04-141 Warsaw, Poland; (E.R.); (K.K.); (A.R.)
| | - Piotr Rzepecki
- Department of Internal Medicine and Hematology, Military Institute of Medicine, Szaserów 128, 04-141 Warsaw, Poland;
| | - Andrzej Chciałowski
- Department of Infectious Diseases and Allergology, Military Institute of Medicine, Szaserów 128, 04-141 Warsaw, Poland; (K.K.); (K.P.); (A.C.)
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17
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Ruling Out Coronavirus Disease 2019 in Patients with Pneumonia: The Role of Blood Cell Count and Lung Ultrasound. J Clin Med 2021; 10:jcm10163481. [PMID: 34441777 PMCID: PMC8397060 DOI: 10.3390/jcm10163481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/28/2021] [Accepted: 07/30/2021] [Indexed: 12/15/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is characterized by a distinctive blood leucocyte pattern and B-lines on lung ultrasound (LUS) as marker of alveolar-interstitial syndrome. We aimed to evaluate the accuracy of blood leucocyte count alone or in combination with LUS for COVID-19 diagnosis. We retrospectively enrolled consecutive patients diagnosed with community acquired pneumonia (CAP) at hospital admission to derive and validate cutoff values for blood cell count that could be predictive of COVID-19 before confirmation by the nucleic acid amplification test (NAAT). Cutoff values, generated and confirmed in inception (41/115, positive/negative patients) and validation (100/180, positive/negative patients) cohorts, were ≤17 and ≤10 cells/mm3 for basophils and eosinophils, respectively. Basophils and/or eosinophils below cutoff were associated with sensitivity of 98% (95%CI, 94–100) and negative likelihood ratio of 0.04 (95%CI, 0.01–0.11). In a subgroup of 265 subjects, the sensitivity of B-line on LUS was 15% lower (p < 0.001) than that of basophils and/or eosinophils below cutoff. The combination of B-lines with basophils and eosinophils below cutoff was associated with a moderate increase of the positive likelihood ratio: 5.0 (95%CI, 3.2–7.7). In conclusion, basophil and eosinophil counts above the generated cutoff virtually rule out COVID-19 in patients with CAP. Our findings can help optimize patient triage pending the NAAT results.
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Małecka-Giełdowska M, Fołta M, Wiśniewska A, Czyżewska E, Ciepiela O. Cell Population Data and Serum Polyclonal Immunoglobulin Free Light Chains in the Assessment of COVID-19 Severity. Viruses 2021; 13:v13071381. [PMID: 34372587 PMCID: PMC8310347 DOI: 10.3390/v13071381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/03/2021] [Accepted: 07/07/2021] [Indexed: 12/26/2022] Open
Abstract
Distinguishing between severe and nonsevere COVID-19 to ensure adequate healthcare quality and efficiency is a challenge for the healthcare system. The aim of this study was to assess the usefulness of CBC parameters together with analysis of FLC serum concentration in risk stratification of COVID-19. Materials and methods: CBC was analyzed in 735 COVID ICU, COVID non-ICU, and non-COVID ICU cases. FLC concentration was analyzed in 133 of them. Results: COVID ICU had neutrophils and lymphocytes with the greatest size, granularity, and nucleic acid content. Significant differences in concentrations of κ and λ FLCs were shown between COVID ICU and COVID non-ICU. However, no difference was found in the κ/λ ratio between these groups, and the ratio stayed within the reference value, which indicates the presence of polyclonal FLCs. FLC κ measurement has significant power to distinguish between severe COVID-19 and nonsevere COVID-19 (AUC = 0.7669), with a sensitivity of 86.67% and specificity of 93.33%. The κ coefficients’ odds ratio of 3.0401 was estimated. Conclusion: It can be concluded that the results obtained from the measure of free light immunoglobulin concentration in serum are useful in distinguishing between severe and nonsevere COVID-19.
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Affiliation(s)
- Milena Małecka-Giełdowska
- Department of Laboratory Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.W.); (E.C.); (O.C.)
- Central Laboratory of Central Teaching Hospital, University Clinical Center of Medical University of Warsaw, 02-097 Warsaw, Poland
- Correspondence: ; Tel.: +48-22-599-2105
| | - Maria Fołta
- Students Scientific Group of Laboratory Medicine, Department of Laboratory Medicine, Faculty of Pharmacy, Medical University of Warsaw, 02-097 Warsaw, Poland;
| | - Agnieszka Wiśniewska
- Department of Laboratory Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.W.); (E.C.); (O.C.)
- Central Laboratory of Central Teaching Hospital, University Clinical Center of Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Emilia Czyżewska
- Department of Laboratory Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.W.); (E.C.); (O.C.)
- Central Laboratory of Central Teaching Hospital, University Clinical Center of Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Olga Ciepiela
- Department of Laboratory Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.W.); (E.C.); (O.C.)
- Central Laboratory of Central Teaching Hospital, University Clinical Center of Medical University of Warsaw, 02-097 Warsaw, Poland
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19
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Martens RJH, Leers MPG. Letter in reply to the letter to the editor of Harte JV and Mykytiv V with the title "A panhaemocytometric approach to COVID-19: a retrospective study on the importance of monocyte and neutrophil population data". Clin Chem Lab Med 2021; 59:e173-e174. [PMID: 33742568 DOI: 10.1515/cclm-2021-0275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/03/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Remy J H Martens
- Department of Clinical Chemistry and Hematology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Math P G Leers
- Department of Clinical Chemistry and Hematology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
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20
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Harte JV, Mykytiv V. A panhaemocytometric approach to COVID-19: a retrospective study on the importance of monocyte and neutrophil population data on Sysmex XN-series analysers. Clin Chem Lab Med 2021; 59:e169-e172. [PMID: 33711224 DOI: 10.1515/cclm-2021-0096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/02/2021] [Indexed: 12/20/2022]
Affiliation(s)
- James V Harte
- Haematology Department, Cork University Hospital, Cork, Ireland
| | - Vitaliy Mykytiv
- Haematology Department, Cork University Hospital, Cork, Ireland
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21
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Nasonov EL. Coronavirus disease 2019 (COVID-19) and autoimmunity. RHEUMATOLOGY SCIENCE AND PRACTICE 2021. [DOI: 10.47360/1995-4484-2021-5-30] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The coronavirus 2019 pandemic (coronavirus disease, COVID-19), etiologically related to the SARS-CoV-2 virus (severe acute respiratory syndrome coronavirus-2), has once again reawakened healthcare professionals’ interest towards new clinical and conceptual issues of human immunology and immunopathology. An unprecedented number of clinical trials and fundamental studies of epidemiology, virology, immunology and molecular biology, of the COVID-19 clinical course polymorphism and pharmacotherapy have been conducted within one year since the outbreak of 2019 pandemic, bringing together scientists of almost all biological and physicians of almost all medical specialties. Their joint efforts have resulted in elaboration of several types of vaccines against SARS-CoV-2 infection and, in general, fashioning of more rational approaches to patient management. Also important for COVID-19 management were all clinical trials of biologics and “targeted” anti-inflammatory drugs modulating intracellular cytokine signaling, which have been specifically developed for treatment immune-mediated inflammatory rheumatic disease (IMIRDs) over the past 20 years. It became obvious after a comprehensive analysis of the entire spectrum of clinical manifestations and immunopathological disorders in COVID-19 is accompanied by a wide range of extrapulmonary clinical and laboratory disorders, some of which are characteristic of IMIRDs and other autoimmune and auto-in-flammatory human diseases. All these phenomena substantiated the practice of anti-inflammatory drugs repurposing with off-label use of specific antirheumatic agents for treatment of COVID-19. This paper discusses potential use of glucocorticoids, biologics, JAK inhibitors, etc., blocking the effects of pro-inflammatory cytokines for treatment of COVID-19.
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Affiliation(s)
- E. L. Nasonov
- V.A. Nasonova Research Institute of Rheumatology; I.M. Sechenov First Moscow State Medical University of the Ministry of Health Care of Russian Federation (Sechenov University)
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22
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Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry, Department of Neuroscience, Biomedicine and Movement, Clinical Chemistry and Laboratory Medicine, University of Verona, Verona, Italy
| | - Mario Plebani
- Department of Laboratory Medicine, Clinical Chemistry and Laboratory Medicine, University Hospital of Padova, Padova, Italy
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