COVID-19-Related Hematological Abnormalities Among Adults; A Cross-Sectional Study in a Resource-Limited Setting

Alterations in hematological parameters in SARS-CoV-2 infection may contribute to disease severity and poor outcomes. This study reports the hematological profile of COVID-19 patients.

This was a cross-sectional study involving 169 confirmed COVID-19 patients conducted at Sunyani Teaching Hospital between January and August, 2022. Sociodemographic, clinical, and laboratory data were obtained. Full blood count was performed using an automated hematology analyzer, and systemic inflammatory indices were calculated.

Participants were mostly young adults (51.5%), females (53.8%), resided in urban settings (41.4%), and aged 20-81 years with a median age of 35.0 (29.0-47.0) years. Overall, anemia was present in 60.4% of the COVID-19 patients (56.4% in males and 63.7% in females), with 23.7%, 23.7%, and 13.0% experiencing mild, moderate, and severe anemia, respectively. The COVID-19 patients mostly had normocytic normochromic anemia (50.3%), and 37.9% had macrocytic normochromic anemia. Older adults (6.600 times, p = 0.004), middle-aged adults (4.435 times, p = 0.034), and rural dwellers (3.759 times, p = 0.012) were associated with anemia among the COVID-19 patients. Thrombocytopenia was detected in 56.2% of the patients, and 36.7%, 16.0%, and 2.4% had mild, moderate and severe thrombocytopenia respectively. Leucocyte alterations among the patients included leucopenia (22.5%), leucocytosis (17.2%), neutropenia (40.8%), and lymphocytosis (39.6%). Total leucocyte count (AUC: 0.818, p < 0.001), absolute neutrophil count (AUC: 0.816, p < 0.001), and absolute lymphocyte count (AUC: 0.804, p < 0.001) predicted severe COVID-19 among the participants. Bicytopenia and pancytopenia were observed in 37.3% and 17.8%, respectively.

COVID-19 is associated with diverse and clinically relevant hematological abnormalities, remarkably anemia, thrombocytopenia, and leucocyte alterations, and usually relate with disease severity. Routine blood cell analysis is essential in the management of COVID-19, particularly in resource-limited settings.