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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 6  |  Issue : 3  |  Page : 422-428

Relationship between the hematological indices and COVID-19


1 Department of Histopathology and Cytology, Faculty of Medical Laboratory Sciences, National University, 3Department of Immunology, Faculty of Medical Laboratory Sciences, Napata College, Khartoum, Sudan
2 Department of Microbiology, Faculty of Medical Laboratory Sciences, University of El Imam El Mahdi, Kosti, Sudan
3 Department of Immunology, Faculty of Medical Laboratory Sciences, Napata College, Khartoum, Sudan

Date of Submission01-Jun-2022
Date of Decision11-Jul-2022
Date of Acceptance12-Aug-2022
Date of Web Publication17-Sep-2022

Correspondence Address:
Abdalkhalig Elkhider
Department of Immunology, Faculty of Medical Laboratory Science, Napata College, Khartoum
Sudan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bbrj.bbrj_151_22

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  Abstract 


Background: Recently, the novel coronavirus disease-2019 (COVID-19) has a wide spread around the world. Clinically, it was responsible for respiratory illness ranged from mild to life-threatening infection. The study aimed to investigate the link of gender, age, ABO blood groups, and hematological indices with COVID-19 infection. Methods: One hindered COVID-19 cases, as confirmed using reverse transcription–polymerase chain reaction test, were checked for some sociodemographic features, blood group, and hematology parameters. A blood sample was collected from each person in an EDTA container and immediately tested for blood group using commercial antisera, in addition to complete blood count parameters using of a semiautomated hematology analyzer (Mindray BC-3200). Results: Of 100 COVID-19 patients, 52% were male and 48% were female. About 33% and 31% of the study participants were of age group 15–31 and 32–49 years, respectively. The majority (37%) of COVID-19 patients carried blood group O+ve, followed by A+ve (24%). A+ve blood group was significantly more reported in males (32.7%) than females (14.6%). Notably, 61% of participants showed low Hb level. Erythropenia was detected in 41% of the participants, while thrombocytopenia was observed only in 19% of the patients. Moreover, lymphocytopenia was detected in 82%, low packed cell volume in 66%, decreased mean corpuscular volume in 20%, and declined mean corpuscular hemoglobin concentration in 8% of the participants. In contrast, leukocytosis and neutrophilia were found in 69% and 73% of the participants, respectively. Conclusion: Taken together, the study findings highlighted the link of COVID-19 with age, gender, blood groups, and hematology parameters, which is important in diagnosis, prognosis, and management of illness.

Keywords: Blood group, complete blood count, COVID-19, hematology parameters, Sudan


How to cite this article:
Khalil NA, Almugadam BS, Elkhider A. Relationship between the hematological indices and COVID-19. Biomed Biotechnol Res J 2022;6:422-8

How to cite this URL:
Khalil NA, Almugadam BS, Elkhider A. Relationship between the hematological indices and COVID-19. Biomed Biotechnol Res J [serial online] 2022 [cited 2022 Nov 28];6:422-8. Available from: https://www.bmbtrj.org/text.asp?2022/6/3/422/356147




  Introduction Top


Coronavirus disease-2019 (COVID-19) is a newly discovered strain of coronavirus. It caused an outbreak of respiratory illness, which was first detected in Wuhan (China) in December 2019.[1] Clinically, it is responsible for respiratory illness ranged from mild to life-threatening infection and with 2.3%–3% case fatality rate as reported in most studies.[2],[3] The common symptoms were cough, fever, and fatigue. Often, the infected individual may develop shortness of breaths and several complications.[2] It also associated with numerous coinfections.[1],[3] Some people are at higher risk of getting COVID-19, including older adults and those who complained of serious chronic medical condition like diabetes.[4] COVID-19 mainly spreads through the air when people are near each other long enough, primarily through small droplets.[1],[3]

The COVID-19 pandemic was confirmed to have spread to Africa on mid-February 2020.[3] Later, the virus reached Sudan in March 2020. Exactly, on March 13, Sudan reported its first case in Khartoum, a man who died on March 12, 2020, after he visited the United Arab Emirates in the 1st week of March.[5] Globally, the reverse transcription–polymerase chain reaction (RT-PCR) is the common method for the diagnoses of SARS-CoV-2. This test is also a gold standard method. Other diagnostic tests include enzyme-linked immunosorbent and immunofluorescence assays.[6]

Some published studies of scholars from all over the world suggested the link of hematology parameters and sociodemographic features with morbidity, severity, or mortality of COVID-19.[7],[8] The researchers also proposed the association of ABO with COVID-19.[9],[10],[11] Blood type may play a key role in determining who contracts COVID-19 and how severe the illness becomes;[9],[10],[11] however, the influence of blood type on clinical outcomes of infection remains indistinct. In this research, we aimed to assess the link of gender, age, blood groups, and hematological parameters with the COVID-19 infection.


  Methods Top


This was a descriptive cross-sectional study conducted at the National Public Health laboratory from 2020 to 2021. The National Public Health laboratory is located in Khartoum, Sudan. The study was approved by the Ethics Research Committee of the National Public Health laboratory, Khartoum, Sudan.

Ethical consideration

The study was approved by the Ethics Committee of the Ministry of Health, Khartoum.

Participants consent

Written informed consent was provided by every participant.

Study population and data collection

The study included COVID-19 patients who attended the National Public Health Laboratory for medical checkups. During the study duration, all the COVID-19-positive cases were enrolled. The study data were collected using an instructed questionnaire.

Study protocol

A nasal swab was obtained from each individual. Subsequently, every sample was subjected to RNA extraction and RT-PCR test for the detection of COVID-19 nucleic acid. Moreover, a venous blood sample was also collected from each COVID-19-positive case in an EDTA container and used for complete blood count (CBC) and blood grouping.

Nasal swab collection, RNA extraction, and reverse transcription–polymerase chain reaction

From the study cases, nasal swab was obtained as described previously.[10] Each sample was immediately placed in viral transport media (Transport and Preservation Medium* Biocomma*) that contain antifungal and antibiotic.[11] The extraction of RNA from the nasal swab was done by an automated extraction machine (Bioneer “ExiPrepTM 48”) using commercial kits (ExiPrepTM 48 Viral RNA Kit). ExiPrepTM 48 Viral RNA Kit is an in vitro diagnostic kit designed for the extraction of viral RNA from a nasopharyngeal swab through particular nucleic acid device, delivering up to 48 extracted samples, and it contains all buffers necessary for efficient extraction of viral nucleic acid from samples.

Viral RNA was extracted from samples using a lysis buffer (Buffer Cartridge 2) to disrupt viral structure, and the binding buffer contains guanidine thiocyanate, which act as a chaotropic agent. The binding buffer disassociates water molecules from nucleic acids and silica magnetic beads. This induces negative charge to nucleic acid and positive to silica magnetic beads. As a result, it exposed viral RNA to the surface of the beads. The washing buffer (Buffer Cartridge 1) rinses any impurity that may exist. Then, magnetic field is used to separate viral RNA from impurities. The elution buffer dissolves purified RNA from the beads. First, we took the sample into a sample loading tube-IPC, and then put it in sample tube rack. After that, we took the sample tube rack and loaded onto the setup tray. Then, we turned on the equipment. Subsequently, when it is completed, we opened the door and took out the setup tray and elution tube track from setup tray, and removed protection cover using a protection cover separation tool. Then, we caped the elution tubes with the supplied elution tubes caps. Here, we get pure RNA. Finally, we removed all consumable and components from the instruments (buffer cartridges, racks, and discard all liquid in their containers).

In RT-PCR, we transferred 15 ml per well from master mix and added 5 ml of sample to each well for a final reaction volume of 20 ml. Finally, we ran the PCR machine (RT-PCR LightCycler R480 II) or thermal cycler and read results as following: select the color compensation, using the second derivative maximum method (Automated F max), view results in the FAM (ORF Gene) and VIC (N Gene) channels, the CY5 fir internal control (IC). The negative control must show no single.

Blood sample collection and laboratory examination

3–5 ml of venous blood sample was collected from each patient in an EDTA container and analyzed immediately. Blood grouping was performed by the slide technique using commercial antisera. The CBC was performed using Mindray BC-3200 (full blood analysis semiautomated hematology analyzer).

Statistical analysis

The categorical data were analyzed using SPSS Software (version 21). Whereas, the numerical data were analyzed using the GraphPad Prism version 7 Software. The data were presented as number, percentage, and mean ± standard deviation (SD). Pearson's Chi-squared, Chi-squared continuous correction, and Fisher's exact tests (categorical data) as well as unpaired t-test and Kruskal–Wallis test (numerical data) were used to evaluate the statistical variation between the groups. P < 0.05 was considered statistically significant.


  Results Top


Characteristics of study subjects

[Table 1] and [Table 2] display the main features of the study participants. From 100 COVID-19 patients studied, 52% were male and 48% were female. 33% and 31% of the study participants were of age group 15–31 and 32–49 years, respectively. The majority (37%) of COVID-19 patients carried blood group O+ve, followed by A+ve (24%). In contrast, AB-ve and B-ve were less frequently detected [Table 1]. A+ve blood group was significantly (X2 = 4.488, P = 0.034) more reported in males (32.7%) than females (14.6%). Multiple variations in frequency of blood groups among COVID-19 patients were also observed; however, there was no significant difference in the distribution of blood groups among gender or age. The frequency of B+ve (X2 = 0.016), B-ve (X2 = 0.596), AB+ve (X2 = 0.016), and O-ve (X2 = 1.211) blood groups was more in females than males, P > 0.05. On the other hand, A+ve (X2 = 0.941, P = 0.825) and B + ve (X2 = 2.871, P = 0.361) blood groups were more frequently in the 67–83 years' age group than other. Whereas, A-ve (X2 = 1.480), B-ve (X2 = 2.771), and O-ve (X2 = 1.854) blood groups were more reported in the 15–31 years' age group compared to other, P > 0.05 [Table 2].
Table 1: Characteristic of coronavirus disease-2019 patients

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Table 2: Link of gender and age with blood group in coronavirus disease-2019 patients

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Effect of COVID-19 hematology indices

To investigate the link of COVID-19 with the hematological parameters, CBC was performed. In this study, the level of Hb, red blood cells, platelets, white blood cells (WBCs), neutrophil, lymphocyte, packed cell volume (PCV), mean corpuscular volume (MCV), MCV, and mean corpuscular hemoglobin concentration (MCHC) was 11.9 ± 1.9, 3.9 ± 0.5, 274.7 ± 128.4, 9.9 ± 4.2, 78.6 ± 10.7, 13.9 ± 6.8, 35.3 ± 9.2, 83.2 ± 11.4, 29.6 ± 2.0, and 34.7 ± 3.5, respectively [Figure 1]a and [Figure 1]b. Notably, 61% of participants showed low Hb level. Erythropenia was detected in 41% of the participants, while the thrombocytopenia observed only in 19% of cases. Moreover, lymphocytopenia was detected in 82%, low PCV in 66%, decreased MCV in 20%, and declined MCHC in 8% of the participants. In contrast, leukocytosis and neutrophilia were found in 69% and 73% of the study patients, respectively. In this study, thrombocytosis was only detected in 11% of the participants [Figure 1]c. On the other hand, all of gender [Figure 2]a, [Figure 2]b, [Figure 2]c, [Figure 2]d, [Figure 2]e, [Figure 2]f, [Figure 2]g, [Figure 2]h, [Figure 2]i, [Figure 2]j, blood group [Figure 3]a, [Figure 3]b, [Figure 3]c, [Figure 3]d, [Figure 3]e, [Figure 3]f, [Figure 3]g, [Figure 3]h, [Figure 3]i, [Figure 3]j, and age [Figure 4]a, [Figure 4]b, [Figure 4]c, [Figure 4]d, [Figure 4]e, [Figure 4]f, [Figure 4]g, [Figure 4]h, [Figure 4]i, [Figure 4]j displayed no significant impact on the hematologic parameters.
Figure 1: Link of COVID-19 with the hematological parameters. (a) Level of the hematological parameters in COVID-19 patients, data presented as mean ± standard deviation. (b) Interpretation of the level of hematological parameters, data presented as percentage. (c) Level of the hematological parameters showed as normal, high, and low in COVID-19 patients, data presented as percentage

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Figure 2: Effect of gender on the hematological parameters in COVID-19. (a-j) Level of hematological parameters (a: Hb, b: RBCs, c: Platelets, d: WBCs, e: Neutrophil, f: Lymphocyte, g: PCV, h: MCV, i: MCH, j: MCHC) in COVID-19 patients, data presented as mean ± standard deviation. Statistical analysis was performed by unpaired t-test. ns: P > 0.05. RBC: Red blood cell, WBC: White blood cell, PCV: Packed cell volume, MCV: Mean corpuscular volume, MCH: Mean corpuscular hemoglobin, MCHC: Mean corpuscular hemoglobin concentration

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Figure 3: Influence of blood groups on the hematological parameters in COVID-19. (a-j) Level of hematological parameters (a: Hb, b: RBCs, c: Platelets, d: WBCs, e: Neutrophil, f: Lymphocyte, g: PCV, h: MCV, i: MCH, j: MCHC) in COVID-19 patients, data presented as mean ± standard deviation. Statistical analysis was performed by Kruskal–Wallis test. ns: P > 0.05. RBC: Red blood cell, WBC: White blood cell, PCV: Packed cell volume, MCV: Mean corpuscular volume, MCH: Mean corpuscular hemoglobin, MCHC: Mean corpuscular hemoglobin concentration

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Figure 4: Impact of age groups on the hematological parameters in COVID-19. (a-j) Level of hematological parameters (a: Hb, b: RBCs, c: Platelets, d: WBCs, e: Neutrophil, f: Lymphocyte, g: PCV, h: MCV, i: MCH, j: MCHC) in COVID-19 patients, data presented as mean ± standard deviation. Statistical analysis was performed by Kruskal–Wallis test. ns: P > 0.05, **P > 0.01. RBC: Red blood cell, WBC: White blood cell, PCV: Packed cell volume, MCV: Mean corpuscular volume, MCH: Mean corpuscular hemoglobin, MCHC: Mean corpuscular hemoglobin concentration

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  Discussion Top


The rapid spread of the COVID-19 has been a major global health challenge.[2] To date, there are only few data about the relationship between COVID-19 and risk factors. Identifying the link of COVID-19 with age, gender, and hematologic parameters is essential in diagnosis, prevention, and control of illness.[12],[13],[14],[15],[16],[17] In this study, we found that 52% of the study cases were male. As well, 33% and 31% of the study cases were in the age group of 15–31 and 32–49 years, respectively. In line with this study, frontiersin.org study reported that men's cases tended to be more serious than women's.[15] Unlike our study, Jie Qian's study found that females have higher susceptibility than males.[16] Interestingly, the majority (37%) of COVID-19 patients in our study carried blood group O +ve, followed by A+ve (24%). In this study, A + ve blood group was significantly more reported in males than females. There was no significant variation in the distribution of blood groups among gender or age. In agreement with this study, Christopher's study found that the most infected cases (45.5%) carried a O blood group, followed by A (34.2%).[18] In contrast, Göker et al.'s study found that the most frequently detected blood group among the COVID-19 patients was A (57%), followed by blood group O (24.8%).[19] Compatible to Simran's study,[13] only 3% and 2% of our study participants carried AB-ve and B-ve blood groups, respectively. Unlike our study, the study of Ghada Ali Aljanobi found that the patients with AB blood group have higher susceptibility, while patients with O blood group have lower susceptibility to COVID-19 infection.[14] The variation between the studies may result from the difference in study area and population, sample size, and other factors. Interestingly, 61% of participants in the current study showed low Hb level. Similarly, erythropenia was detected in 41% of the participants, while the thrombocytopenia observed only in 19% of patients. Moreover, lymphocytopenia was detected in 82%, low PCV in 66%, decreased MCV in 20%, and declined MCHC in 8% of the participants. This is in line with Xiaoqing et al.'s[9] and Czeisler Mة et al.'s studies.[16] Similar to our study, the study of Li Yang reported that lymphopenia is a key feature of patients with COVID-19. Notably, leukocytosis and neutrophilia were found in 69% and 73% of the current study participants, respectively. The previous studies showed similar results.[20],[21] Seied Asadollah Mousavi also found that the percentage of neutrophil in COVID-19 patients was very high (neutrophilia).[18] All together, these findings highlighted the relationship of COVID-19 with age, gender, blood group, and hematology parameters, which are of value in diagnosis, prevention, and management of the disease.


  Conclusion Top


The study findings showed the effect of COVID-19 on hematology indices. Leukocytosis, neutrophilia, lymphocytopenia, and low PCV are a predicator of COVID-19.

Limitation of study

They include the use of cross-sectional study design, since in this type of work, the use of comparative design and including of health control group can provide more accurate outcome.

Acknowledgment

The authors acknowledge the staff of the National Public Health Laboratory and the study participants.

Financial support and sponsorship

Nil.

Conflict of interests

There are no conflicts of interest.



 
  References Top

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