Estimation of Thrombocytopenia in Patients of COVID-19 in a Tertiary Care Centre as a Prognostic marker

##plugins.themes.academic_pro.article.main##

Devangana Rajyaguru
Preeti Bajaj
Gayatri Soneta
Aakash Gupta

Abstract

Introduction: Severe COVID-19 can lead to critical illness, with Acute Respiratory Distress (ARDS) and Multi-organ Failure (MOF) as its primary complications, eventually followed by intravascular coagulopathy. Haematological changes are common in patients with COVID-19, which include reduced lymphocyte count and platelet count but normal white blood cell count and prolonged activated partial thromboplastin time. Using a simple test like platelet count for assessing the risk of mortality and early identification of severe cases will help in preventing the life threatening complications in patients of COVID-19. Aims and Objectives: To study trends of thrombocytopenia in patients of COVID-19 and to study the correlation between thrombocytopenia and severity of cases of COVID-19. Materials and Methods: The study was carried out in Central Clinical Laboratory in a tertiary care centre. A total of 138 random subjects who were admitted in the COVID ICU were included after they satisfied the eligibility criteria. The CBCs were analyzed on the Beckmann Coulter automated cell count analyzer with EDTA samples obtained from peripheral venipuncture of the patients. Platelet trends over the three samples were studied. Results: An average of all three platelets counts for the patients revealed an overall decreasing trend in cases of non survivors, whereas an overall upward trend was noted in the survivors. A total of 79 patients showed thrombocytopenia (platelet count less than 1.5 lakhs/mm3), during at least one of the tests.46 (33.33%) of these patients succumbed, whereas 33 (23.9%) patients survived. Decreasing trends or overall decreasing trends (Increasing then decreasing) were observed in larger number of non survivors as compared to survivors. Also increasing or overall increasing trends (decreasing then increasing) were common in the survivors. Discussion: Hematological changes are common in SARS patients. For thrombocytopenia, the possible mechanisms of SARS-CoV associated thrombocytopenia may include, 1. Direct infection of megakaryocytes and platelets potentially, inducing cell apoptosis and growth inhibition and/or 2. Immune damage of megakaryocyte progenitor cells or platelets; In addition, the lung damage in SARS patients may also play a role in inducing thrombocytopenia. Conclusion: In this study, we found that platelet count may be a simple, economic, rapid and commonly available laboratory parameter that could straightforwardly discriminate between COVID patients with and without severe disease, while the study of serial platelets counts as trends could help identifying those with a serious risk of mortality.

##plugins.themes.academic_pro.article.details##

How to Cite
Rajyaguru, D. ., Bajaj, P., Soneta, G. ., & Gupta, A. . (2022). Estimation of Thrombocytopenia in Patients of COVID-19 in a Tertiary Care Centre as a Prognostic marker. MVP Journal of Medical Sciences, 191–198. https://doi.org/10.18311/mvpjms/2021/v8i2/274

References

  1. Phan LT, Nguyen TV, Luong QC, Nguyen TV, Nguyen HT, Le HQ et al. Importation and human-to-human transmission of a novel Coronavirus in Vietnam. N Engl J Med. 2020; 382(9):872–74. PMid: 31991079 PMCid: PMC7121428. https://doi.org/10.1056/NEJMc2001272 DOI: https://doi.org/10.1056/NEJMc2001272
  2. Rothe C, Schunk M, Sothmann P, Bretzel G, Froeschl G, Wallrauch C, et al. Transmission of 2019-nCoV infection from an asymptomatic contact in Germany. N Engl J Med. 2020; 382:97-–1. PMid: 32003551 PMCid: PMC7120970. https://doi.org/10.1056/NEJMc2001468 DOI: https://doi.org/10.1056/NEJMc2001468
  3. Holshue ML, DeBolt C, Lindquist S, Lofy KH, Wiesman J, Bruce H, et al. First case of 2019 novel Coronavirus in the United States. N Engl J Med. 2020; 382:929–36. PMid: 32004427 PMCid: PMC7092802. https://doi.org/10.1056/NEJMoa2001191 DOI: https://doi.org/10.1056/NEJMoa2001191
  4. Chen Z, Zhang W, Lu Y, Guo C, Guo Z, Liao C, et al. From SARS-CoV to Wuhan 2019-nCoV outbreak: Similarity of early epidemic and prediction of future trends. BioRxiv. 2020. https://doi.org/10.1101/2020.01.24.919241 https://doi.org/10.2139/ssrn.3528722 DOI: https://doi.org/10.2139/ssrn.3528722
  5. The L Emerging understandings of 2019-nCoV. Lancet. 2020; 395(10221):311. https://doi.org/10.1016/S01406736(20)30186-0 DOI: https://doi.org/10.1016/S0140-6736(20)30186-0
  6. Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new Coronavirus of probable bat origin. Nature. 2020; 579:270–3. PMid: 32015507 PMCid: PMC7095418. https://doi.org/10.1038/s41586-020-2012-7 DOI: https://doi.org/10.1038/s41586-020-2012-7
  7. Yang M, Ng MHL, Li CK. Thrombocytopenia in patients with severe acute respiratory syndrome (review).
  8. Hematology. 12005; 10:101–5. PMid: 16019455. https://doi.org/10.1080/10245330400026170 DOI: https://doi.org/10.1080/10245330400026170
  9. Mattiuzzi C, Lippi G. Which lessons shall we learn from the 2019 novel Coronavirus outbreak? Annals of Translational Medicine. 2020; 8:48. PMid: 32154288 PMCid: PMC7036635. http://atm.amegroups.com/post/view/which-lessonsshall-we-learn-from-the-2019novel-coronavirus-outbreak https://doi.org/10.21037/atm.2020.02.06 DOI: https://doi.org/10.21037/atm.2020.02.06
  10. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, Qiu Y, Wang J, Liu Y, Wei Y, Xia J, Yu T, Zhang X, Zhang L. Epidemiological and clinical characteristics of 99 cases of 2019 novel Coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet. 2020; 395(10223):507–13. https://doi.org/10.1016/s0140-6736(20)30211-7 DOI: https://doi.org/10.1016/S0140-6736(20)30211-7
  11. WHO-China Joint Mission, Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID19), (2020). https://www.who.int/docs/default-source/coronaviruse/who-chinajoint-mission-on-covid-19-finalreport.pdf
  12. Zarychanski R, Houston DS, Assessing thrombocytopenia in the intensive care unit: The past, present and future. Hematology Am Soc Hematol Educ Program. 2017; 2017:660–6. PMid: 29222318 PMCid: PMC6142536. https://doi.org/10.1182/asheducation-2017.1.660 DOI: https://doi.org/10.1182/asheducation-2017.1.660
  13. Jolicoeur P, Lamontagne L, Impairment of bone marrow pre-B and B cells in MHV3 chronically-infected mice. Adv Exp Med Biol. 1995; 380:193–5. PMid: 8830480. https://doi.org/10.1007/978-1-4615-1899-0_33 DOI: https://doi.org/10.1007/978-1-4615-1899-0_33
  14. Khurana D, Deoke SA. Thrombocytopenia in Critically Ill Patients: Clinical and laboratorial behavior and its correlation with short-term outcome during hospitalization. Indian J Crit Care Med. 2017; 21:861–4. PMid: 29307969 PMCid: PMC5752797. https://doi.org/10.4103/ijccm.IJCCM_279_17 DOI: https://doi.org/10.4103/ijccm.IJCCM_279_17
  15. Vanderschueren S, De Weerdt A, Malbrain M, Vankersschaever D, Frans E, Wilmer A, Bobbaers H. Thrombocytopenia and prognosis in intensive care. Crit Care Med. 2000; 28:1871–6. PMid: 10890635. https://doi.org/10.1097/00003246-200006000-00031 DOI: https://doi.org/10.1097/00003246-200006000-00031
  16. Hui P, Cook DJ, Lim W, Fraser GA, Arnold DM. The frequency and clinical significance of thrombocytopenia complicating critical illness: A systematic review. Chest. 2011; 139:271–8. PMid: 21071526. https://doi.org/10.1378/chest.10-2243 DOI: https://doi.org/10.1378/chest.10-2243
  17. He W, Chen S, Liu X, LI Y, Xiao Z, Zhong N. Death risk factors of Severe Acute Respiratory Syndrome with Acute Respiratory Distress Syndrome. Chinese Critical Care Medicine. 2003; 15:336–7.
  18. Zou Z, Yang Y, Chen J, Xin S, Zhang W, Zhou X, Mao Y, Hu L, Liu D, Chang B, Chang W, Liu Y, Ma X, Wang Y, Liu X. Prognostic factors for Severe Acute Respiratory Syndrome: A clinical analysis of 165 cases. Clin Infect Dis. 2004; 38:483–9. PMid: 14765339 PMCid: PMC7107942. https://doi.org/10.1086/380973 DOI: https://doi.org/10.1086/380973
  19. Choi KW, Chau TN, Tsang O, Tso E, Chiu MC, Tong WL, Lee PO, Ng TK, Ng WF, Lee KC, Lam W, Yu WC, Lai JY, Lai ST. Princess Margaret Hospital SARS Study Group. Outcomes and prognostic factors in 267 patients with Severe Acute Respiratory Syndrome in Hong Kong. Ann Intern Med. 2003; 139(9):715–234. PMid: 14597455. https://doi.org/10.7326/0003-4819-139-9-20031104000005 DOI: https://doi.org/10.7326/0003-4819-139-9-200311040-00005
  20. Wong RS, Wu A, To KF, Lee N, Lam CW, Wong CK, Chan PK, Ng MH, Yu LM, Hui DS, Tam JS, Cheng G, Sung JJ. Haematological manifestations in patients with Severe Acute Respiratory Syndrome: Retrospective analysis. BMJ. 2003; 326:1358–62. PMid: 12816821 PMCid: PMC162124. https://doi.org/10.1136/bmj.326.7403.1358 DOI: https://doi.org/10.1136/bmj.326.7403.1358
  21. Lee N, Hui D, Wu A, et al. A major outbreak of Severe Acute Respiratory Syndrome in Hong Kong. N Engl J Med. 2003; 348:1986–94. PMid: 12682352. https://doi.org/10.1056/NEJMoa030685 DOI: https://doi.org/10.1056/NEJMoa030685
  22. Vu HT, Leitmeyer KC, Le DH, Miller MJ, Nguyen QH, Uyeki TM, Reynolds MG, Aagesen J, Nicholson KG, Vu QH, Bach HA, Plan AJ. Clinical description of a completed outbreak of SARS in Vietnam. Emerg Infect Dis. 2004; 10(2):334–8. PMid: 15030707 PMCid: PMC3322907. https://doi.org/10.3201/eid1002.030761 DOI: https://doi.org/10.3201/eid1002.030761
  23. Liu CL, Lu YT, Peng MJ, Chen PJ, Lin RL, Wu CL, Kuo HT. Clinical and laboratory features of Severe Acute Respiratory Syndrome vis-a-vis onset of fever. Chest. 2004; 126(2):509– 17. DOI: https://doi.org/10.1378/chest.126.2.509
  24. Peiris JS, Lai ST, Poon LL, et al. Coronavirus as a possible cause of Severe Acute Respiratory Syndrome. Lancet. 2003; 361:1319–25. https://doi.org/10.1016/S01406736(03)13077-2 DOI: https://doi.org/10.1016/S0140-6736(03)13077-2
  25. Chan JF, Kok KH, Zhu Z, Chu H, To, K. K, Yuan S, Yuen KY. Genomic characterization of the 2019 novel human pathogenic Coronavirus isolated from a patient with atypical pneumonia after visiting Wuhan. Emerg Microbes Infect. 2020; 9(1):221–36. PMid: 31987001 PMCid: PMC7067204. https://doi.org/10.1080/22221751.2020.171 9902 DOI: https://doi.org/10.1080/22221751.2020.1719902
  26. Yeager CL, Ashmun RA, Williams RK, Cardellichio CB, Shapiro LH, Look AT, Holmes KV. Human aminopeptidase N is a receptor for human Coronavirus 229E. Nature. 1992; 357(6377):420–2. PMid: 1350662 PMCid: PMC7095410. https://doi.org/10.1038/357420a0 DOI: https://doi.org/10.1038/357420a0
  27. Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ. Hlh Across Speciality Collaboration, U. K (2020) COVID-19: Consider cytokine storm syndromes and immune suppression. Lancet. https://doi.org/10.1016/S0140-6736(20)30628-0 DOI: https://doi.org/10.1016/S0140-6736(20)30628-0
  28. Zhou Y, Fu B, Zheng X, Wang D, Zhao C, Qi Y et al. Aberrant pathogenic GM-CSF+ T cells and inflammatory CD14+ CD16+ monocytes in severe pulmonary syndrome patients of a new Coronavirus. BioRxiv. 2020. https://doi.org/10.1101/2020.02.12.945576 DOI: https://doi.org/10.1101/2020.02.12.945576
  29. Lefrancais E, Ortiz-Munoz G, Caudrillier A, Mallavia B, Liu F, Sayah DM, et al. The lung is a site of platelet biogenesis and a reservoir for haematopoietic progenitors. Nature. 2017; 544(7648):105–9. PMid: 28329764 PMCid: PMC5663284. https://doi.org/10.1038/nature21706 DOI: https://doi.org/10.1038/nature21706
  30. Nardi M, Tomlinson S, Greco MA, Karpatkin S. Complement-independent, peroxide-induced antibodylysis of platelets in HIV-1-related immune thrombocytopenia. Cell. 2001; 106(5):551–61. https://doi.org/10.1016/s0092-8674(01)00477-9 DOI: https://doi.org/10.1016/S0092-8674(01)00477-9
  31. Arabi YM, Arifi AA, Balkhy HH, Najm H, Aldawood AS, Ghabashi A, et al. Clinical course and outcomes of critically ill patients with Middle East respiratory syndrome Coronavirus infection. Ann Intern Med. 2014; 160(6):389–97. PMid: 24474051. https://doi.org/10.7326/M13-2486 DOI: https://doi.org/10.7326/M13-2486
  32. Scaradavou A. HIV-related thrombocytopenia. Blood Rev. 2002; 16(1):73–6. PMid: 11914001. https://doi.org/10.1054/blre.2001.0188 DOI: https://doi.org/10.1054/blre.2001.0188
  33. Xu P, Zhou Q. Xu J. Mechanism of thrombocytopenia in COVID-19 patients. 10.1007/s00277-020-04019-0 Annals of Hematolgy. 2020. DOI: https://doi.org/10.1007/s00277-020-04019-0