The COVID-19 pandemic has had a consequential impact on the global health system. Multisystem involvement is common in COVID-19. Many COVID-19 patients also showed changes in haematological parameters. This cross-sectional study included patients who attended the fever clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, with fever and/or upper respiratory symptoms. Demographic information, information regarding symptoms, exposure and comorbidities were collected. Complete blood count profile and C-reactive protein were done. Patients underwent RT-PCR for Covid-19 at the fever clinic. A total of 350 patients were included in the study. The study revealed that 21.4% of respondents were COVID-19 positive. PCR-positive patients were more likely to be symptomatic and had elevated C reactive protein levels. COVID-19 positive patients also showed higher total leucocyte, neutrophil, lymphocyte, eosinophil, basophil, and platelet count.


BSMMU J 2022; 15(2): 75-7

Ismat Ara  Islam

Md Abdul Aziz

Md Akhlak  Ul Islam

Md Raiq Raihan  Chowdhury

Md Salahuddin  Shah

Mily  Dey

Nishat  Mahzabin

Bangabandhu Sheikh Mujib Medical University Journal

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| Original  |  Article | Haematological parameters and SARS-CoV-2 RT PCR positivity among patients at fever clinic in a tertiary care hospital in BangladeshNishat Mahzabin, Md Raiq Raihan Chowdhury, Md Akhlak Ul Islam, Ismat Ara Islam, Mily Dey,  Md Salahuddin Shah, Md Abdul AzizIntroductionCOVID-19 pandemic has been caused by the Severe Acute Respiratory Syndrome – Coronavirus 2 (SARS-CoV-2) virus. The disease was first reported in China in late 2019, but within a short period, it had reached most countries and territories in the World.1, 2 Health authorities across countries struggled to contain the spread of the pandemic and simultaneously manage a large number of patients with the potentially fatal disease due to its little-known pathogen. Infection control and prevention (IPC) is important in combatting the pandemic. Many strategies have been implemented to reduce disease transmission in health care facilities. Dedicated facilities for treating COVID-19 patients had been set up existing facilities designated special corners for managing COVID-19 patients. Triage corners were established to screen and group patients into confirmed, suspected, and non-infected patients in most healthcare facilities. Fever clinics were also set up in some facilities as specialized clinics for patients with fever and/or upper respiratory symptoms. These Article Info AbstractDepartment of Paediatric Haematology & Oncology, Dhaka Medical College Hospital, Dhaka (NM); Department of Haematology, Bangabandhu Sheikh Mujib Medical University, Dhaka (MRRC, MAUI, IAI, MD, MSS, MAA)For Correspondence:  Nishat MahzabinEmail: nishatbsmmu@yahoo.comCite this arcle: Mahzabin N, Chowdhury MRR, Islam MAU, Islam IA, Dey M, Shah MS, Aziz MA. Haematological parameters and SARS-CoV-2 RT PCR posi!vity among pa!ents at fever clinic in a ter!ary care hospital in Bangladesh.  Bangabandhu  Sheikh  Mujib Med Univ J. 2022; 15(2):   75 - 79. Copyright:  The  copyright  of  this  ar!cle  is  retained by the author(s) [Atribu!on CC-By 4.0]   Available at: www.banglajol.info  A Journal of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh The COVID-19 pandemic has had a consequential impact on the global health system.               Multisystem involvement is common in COVID-19. Many COVID-19 patients also showed changes in haematological parameters. This cross-sectional study included patients who attended the fever clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, with fever and/or upper respiratory symptoms. Demographic information, information regarding symptoms, exposure and comorbidities were collected. Complete blood count profile and C-reactive protein were done. Patients underwent RT-PCR for Covid-19 at the fever clinic. A total of 350 patients were included in the study. The study revealed that 21.4% of respondents were COVID-19 positive. PCR-positive patients were more likely to be  symptomatic and had elevated C reactive protein levels. COVID-19 positive patients also showed higher total leucocyte, neutrophil, lymphocyte, eosinophil, basophil, and platelet count.Received               :  8 March, 2022 Accepted              :  30 March 2022 Available Online  :  15 May 2022ISSN: 2224-7750 (Online)           2074-2908 (Print)  DOI: h"ps://doi.org/10.3329/bsmmuj.v15i2.60858Keywords: Covid-19, SARS-CoV-2 RT PCR, Haematological parameters of Covid-19clinics offered clinical consultation, basic haematological and biochemical investigations and Reverse Transcriptase Polymerase Chain Reaction (RT PCR) based on patients’ requirements.Despite being primarily a disease of the respiratory system, Coronavirus Disease - 2019 (COVID-19) may cause other systemic complications during its initial presentation or later during the course of the disease.3 The study explored clinical features, haematological changes of the patients and their potential relationship with the RT PCR positivity for COVID 19.MethodsThis descriptive cross-sectional study included patients who attended the fever clinic in a tertiary care facility in Bangladesh in the early months of the pandemic. All the study participants received the RT-PCR test for COVID-19 at the clinic. A total of 350 patients were included in this study. Complete Blood Count (CBC) and C- reactive protein (CRP) levels were measured on the BSMMU J 2022; 15(2): 75 - 7976Age and Body Mass Index (BMI) of participants and their COVID-19 statusTable-Isame day the samples were taken. The analysis of symptoms, haematological findings, and CRP levels among the fever clinic attendees and their relationship with RT PCR status was carried out using the statistical software - SPSS (Statistical Package for Social Sciences) version 26.ResultsA total of 350 persons attending the fever clinic were included in the study. Among the respondents, majority (64.6%) were aged between 20 and 39 years. Around 26% belonged to the 40-59 years age group. Only 6% were aged 60 years or more. Age distribution was similar across COVID-19 positive and negative groups; mean (sd) age (in years) was 39.1 (11.05) vs. 36.3 (12.17). Mean BMI among COVID positive and negative patients was also similar; BMI (kg/m2) 30.5 (4.93) vs. 30.9 (3.97). Among all the participants, 4.9% were obese and another 31% were overweight (Table– I).Majority (69.7%) of the participants were male. About one-fourth of respondents were healthcare workers. More than 30% had one or more relevant comorbidities. More than 10% of the respondents were active smokers. Among the respondents, 83.8% were symptomatic. Among them, 21.4% were found to be positive for SARS-CoV2 RNA by RT-PCR. Symptomatic patients were much more likely to be tested positive for COVID-19 (24.5% vs 5.4%, p = 0.001). Patients with elevated CRP were also more likely to be positive for COVID-19 (28.8% vs 18.7%, p = 0.035) (Table– II).Symptomatic patients were much more likely to be tested positive for COVID-19 (24.5% vs 5.4%, p = .001). The most common symptoms were fever (63.6%) and cough (45.9%). Patients with fever (p = .001), cough (p=.049), and anosmia (p=.001) were significantly more likely to be positive for COVID-19 (Table – III).As many as 87.1% of respondents were recipients of some form of exposure, most commonly through occupational exposure (57.7%) or through exposure to affected family members (57.4%). At least one comorbidity was present in 30.9% of study participants. Hypertension (15.4%), diabetes (11.8%), and asthma (3.9%) were the most common comorbidities. Among all the participants, 2% were pregnant. Complete blood count (CBC) revealed that COVID-19-positive patients had higher total leucocyte, neutrophil, lymphocyte, eosinophil, basophil, and platelet counts (p < .05).Variable                                                        COVID-19  p-value* Positive (n=76) Negative (n=278) Age (years) (Mean±SD)  39.1 (± 11.05) 36.3 (± 12.17) 0.072BMI (kg/m2) (Mean±SD)  30.5 (± 4.93) 30.9 (± 3.97) 0.464*significance at 5% level, t-test CRP level and COVID-19 status among study participantsTable-II                                                 COVID-19  Total  Positive, n (%) Negative, n (%) CRP Elevated 30 (28.8) 74 (71.2)     104 Normal 46 (18.7) 200 (81.3)    246 Total 76 274 350BSMMU J 2022; 15(2): 75 - 79 77Presenting symptoms and COVID-19 status of the study participantsTable-IIISymptoms                                                                                                           COVID-19  Positive Negative   (n=76, 21.4%) (n=278, 78.6%)Fever (n=226) Present (226) 63 (27.9) 163 (72.1) Absent (128) 13 (10.1) 115 (89.8)Cough (n=164) Present (164) 43 (26.2) 121 (73.8) Absent (190) 33 (17.4) 157 (82.6)Breathlessness (n=26) Present (26) 7 (26.9) 19 (73.1) Absent (328) 69 (21.0) 259 (79.0)Altered/absent taste sensation (n=46) Present (46) 9 (19.6) 37 (80.4) Absent (308) 67 (21.8) 241 (78.2)Altered/absent smell (n=10) Present(10) 7 (70.0) 3 (30.0) Absent (354) 69 (20.1) 275 (79.9)Complete blood count parameters and COVID-19 status among study respondentsTable-IV                 Variables                                                          COVID-19  p-value* Positive (n=76) Negative (n=278) Hemoglobin (g/dL) 13.7 (12.4-14.7) 13.6 (12.075-14.600) 0.811White Blood Cell (/mm3) 8275 (7142.5-9592.5) 6785 (5830-8045) <0.001Neutrophil (/mm3) 4935 (3922.5-5897.5) 3855 (2965-4840) <0.001Lymphocyte (/mm3) 2620 (2082.5-3127.5) 2360 (1870.0-2797.5) 0.027Neutrophil: Lymphocyte ratio 1.9 (1.45-2.5225) 1.7 (1.245-2.310) 0.018Eosinophil (/mm3) 180 (90-290) 90 (40-170) <0.001Basophil (/mm3) 30 (20-40) 10 (10-20) <0.001Monocyte (/mm3) 380 (320-450) 355 (280-445) 0.201Platelet (×103/mm3) 258.5 (213.5- 317.75) 233 (199-296.25) 0.033*significance at 5% level, Man-Whitney test DiscussionThis study was conducted at the fever clinic established in the initial days of the COVID-19 pandemic. It was intended to gather a cross-sectional picture of their presentations, COVID-19 positivity and any possible correlation with symptoms, complete blood count parameters and C-reactive protein level. A significant proportion of the respondents were health care workers and first responders. They were more exposed to the virus during the early days of the pandemic due to their occupational responsibilities. This may also reflect their high level of awareness regarding the importance of early detection of COVID-19. In another study conducted in the fever clinic4, only COVID-19-positive patients were included. In that study, the patient population had similar age and BMI distribution, which is comparable to ours. In both studies, fever and cough were the most common symptoms, and diabetes mellitus, hypertension and asthma were the most common comorbidities. A positive relation was found between having fever, cough or anosmia with a positive RT PCR test for COVID-19. Haematological changes in COVID-19 are mostly nonspecific. Most common among these changes are lymphopenia, BSMMU J 2022; 15(2): 75 - 7978elevated Lactate Dehydrogenase (LDH), and elevated inflammatory markers, including C-reactive protein (CRP).5-9 These changes are more frequent in the earlier phases of the disease than in later phases.5 Besides, neutrophilia, eosinopenia, mild thrombocytopenia, and rarely thrombocytosis were also seen.10-17 It was found that lymphopenia was more common and severe in patients with severe diseases.Similarly, the elevation of C-reactive protein (CRP) was more common in the later period of the disease and was more marked in cases of severe disease.5,18-23 Besides, there have been reports of various morphological changes in peripheral blood cells in different phases of the disease. In the early days, pronounced granulocytic reaction with features of dysplasia, immaturity, and apoptotic- degenerative changes, including hypolobation, hypogranulation, hypergranulation, vacuolation, and pseudo-pelger-like morphology, were found. Morphological changes in platelets also were seen. In the later phase of the disease, features of lymphocyte activation and heterogoeneous lymphocyte morphology, including large atypical lymphocytes, lymphoplasmacytic cells, and increased large granular lymphocytes were noted.5,24-27 A rare case of leucoerythroblastic blood picture has been reported in COVID-19.28 These findings have been found in studies carried out among the different population.29-32 Majority of the patients attending the fever clinic have been clinically stable and presented in the early days of symptoms onset compared to those presenting to the emergency department. As a result, haematological and biochemical changes indicating the severity of the disease were relatively less common among our study participants.ConclusionThe presence of fever, cough or anosmia, or positive CRP independently correlated with positive COVID-19 RT PCR test among patients attending the fever clinic during the pandemic. Haematological changes in unselected COVID-19 patients are mostly non-specific. Large-scale studies in community settings can be carried out to further analyse the short and long-term effect of COVID-19 on haematological parameters.AcknowledgmentAuthors like to pay their sincere thanks and gratitude to Bangabandhu Sheikh Mujib Medical University, Dhaka for funding this project.References1. Paules CI, Marston HD, Fauci AS. Coronavirus infections-more than just the common cold. JAMA. 2020;323(8):707-702. Jiang S, Du L, Shi Z. An emerging coronavirus causing pneumonia outbreak in Wuhan, China: Calling for developing therapeutic and prophylactic strategies. Emerg Microbes Infect. 2020;9(1):275-73. Huang C, Wang Y, Li X. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-5064. Arafat SM,  Khan AH, Sharmin  E, Alam MA.    Socio-demographic    and    clinical profile  of  the  COVID- 19  positive  cases among the patients attending in the fever clinic   of   a   tertiary   care   hospital   of Bangladesh. Bangabandhu  Sheikh  Mujib Med Univ J. 2021; 14(4): 114-20.5. Lim AYH, Goh JL, Chua MCW, Heng BH, Abisheganaden JA, George PP. Temporal changes of haematological and radiological findings of the COVID-19 infection-a review of literature. BMC Pulm Med. 2021;21(1):37.6.  Xiang J, Chen Z, Zhou J, Tian D, Ran X, Zhang Z, et al. Comparative analysis of the main haematological indexes and RNA detection for the diagnosis of SARS-CoV-2 infection. BMC Infect Dis. 2020;20(1):7797. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al; China Medical Treatment Expert Group for Covid-19.Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382:1708-20.8. Ruan Q, Yang K, Wang W, et al. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan. China Intensive Care Med. 2020;46:846-8.9. Wang F, Nie J, Wang H, Zhao Q, Xiong Y, Deng L, et al. Characteristics of peripheral lymphocyte subset alteration in COVID-19 pneumonia. J Infect Dis. 2020;221(11):1762-9.10. Zini G, Bellesi S, Ramundo F, d'Onofrio G. Morphological anomalies of circulating blood cells in COVID-19. Am J Hematol. 2020;95(7):870-2.11. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13.12. Qian GQ, Yang NB, Ding F, Ma AHY, Wang ZY, Shen YF, et al. Epidemiologic and clinical characteristics of 91 hospitalized patients with COVID-19 in Zhejiang, China: A retrospective, multi-centre case series. QJM 2020;113(7):474-8113. Mo P, Xing Y, Xiao Y, Deng L, Zhao Q, Wang H, et al. Clinical characteristics of refractory COVID-19 pneumonia in Wuhan, China. Clin Infect Dis. 2021; 73(11):e4208-13BSMMU J 2022; 15(2): 75 - 79 7914. Zhang JJ, Dong X, Cao YY, Yuan YD, Yang YB, Yan YQ et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy. 2020;75(7):1730-41.15. Liu F, Xu A, Zhang Y, Xuan W, Yan T, Pan K, et al. Patients of COVID-19 may benefit from sustained lopinavir-combined regimen and the increase of eosinophil may predict the outcome of COVID-19 progression. Int J Inf Dis. 2020;95:183-91.16. Lippi G, Plebani M, Henry BM. Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: a meta-analysis. Clin Chim Acta. 2020;506:145-8.17. Fan BE, Chong VCL, Chan SSW, Lim GH, Lim KGE, Tan GB, et al. Hematologic parameters in patients with COVID-19 infection. Am J Hematol. 2020;95(6):E131-2.18. Danwang C, Endomba FT, Nkeck JR, Wouna DLA, Robert A, Noubiap JJ. A meta-analysis of potential biomarkers associated with severity of coronavirus disease 2019 (COVID-19). Biomark Res. 2020 Aug 31;8:37.19. Liao D, Zhou F, Luo L, Xu M, Wang H, Xia J, et al. Haematological characteristics and risk factors in the classification and prognosis evaluation of COVID-19: a retrospective cohort study. Lancet Haematol. 2020;7(9):e671-8.20. Li X, Liu C, Mao Z, Xiao M, Wang L, Qi S, Zhou F. Predictive values of neutrophil-to-lymphocyte ratio on disease severity and mortality in COVID-19 patients: a systematic review and meta-analysis. Crit Care. 2020;24(1):647. 21. Huang I, Pranata R. Lymphopenia in severe coronavirus disease-2019 (COVID-19): systematic review and meta-analysis. J Intensive Care. 2020;8:36. 22. Barry M, AlMohaya A, AlHijji A, Akkielah L, AlRajhi A, Almajid F, et al. Clinical characteristics and outcome of hospitalized COVID-19 patients in a MERS-CoV endemic area. J Epidemiol Glob Health. 2020;10(3):21423. Alamdari NM, Afaghi S, Rahimi FS, Tarki FE, Tavana S, Zali A, et al. Mortality risk factors among hospitalized COVID-19 patients in a major referral center in Iran. Tohoku J Exp Med. 2020;252(1):73–84.24. Ahnach M, Ousti F, Nejjari S, Houssaini MS, Dini N. Peripheral Blood Smear Findings in COVID-19. Turk J Haematol. 2020;37(4):310-302. 25. Mungmunpuntipantip R, Wiwanitkit V. Peripheral Blood Smears in COVID-19: A Comment. Turk J Haematol. 2021;38(1):97-9726. Akçabelen YM, Gürlek Gökçebay D, Yaralı N. Dysplastic Changes of Peripheral Blood Cells in COVID-19 Infection. Turk J Haematol. 2021;38(1):72-3. 27. Berber I, Cagasar O, Sarici A, Berber NK, Aydogdu I, Ulutas O, et al. Peripheral Blood Smear Findings of COVID-19 Patients Provide Information about the Severity of the Disease and the Duration of Hospital Stay. Mediterr J Hematol Infect Dis. 2021 Jan 1;13(1):e2021009. 28. Mitra A, Dwyre DM, Schivo M, Thompson GR 3rd, Cohen SH, Ku N, et al. Leukoerythroblastic reaction in a patient with COVID-19 infection. Am J Hematol. 2020;95(8):999-100029. Aggarwal A, Shrivastava A, Kumar A, Ali A. Clinical and epidemiological features of SARS-CoV-2 patients in SARI ward of a tertiary care centre in New Delhi. J Assoc Physicians India. 2020; 68(7):19–26.30. Hong KS, Lee KH, Chung JH, Shin KC, Choi EY, Jin HJ, et al. Clinical features and outcomes of 98 patients hospitalized with SARS-CoV-2 infection in Daegu, South Korea: a brief descriptive study. Yonsei Med J. 2020;61(5):431-731. Yip CY, Yap ES, Mel SD, Teo WZ, Lee CT, Kan S, et al. Temporal changes in immune blood cell parameters in COVID-19 infection and recovery from severe infection. Br J Haematol. 2020; 190(1):33–6.32. Tabata S, Imai K, Kawano S, Ikeda M, Kodama T, Miyoshi K, Obinata H, Mimura S, Kodera T, Kitagaki M. Clinical characteristics of COVID-19 in 104 people with SARS-CoV-2 infection on the Diamond Princess cruise ship: A retrospective analysis. Lancet Infect Dis. 2020;20(9):1043-50

Haematological parameters and SARS-CoV-2 RT PCR positivity among patients at fever clinic in a tertiary care hospital in Bangladesh

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Haematological parameters and SARS-CoV-2 RT PCR positivity among patients at fever clinic in a tertiary care hospital in Bangladesh

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