Medical Laboratory Journal

Evaluation of WBC Parameters and Their Significance in COVID-19 Patients in Western Maharashtra, India

Prachi Kate

Background and objectives: In patients with coronavirus disease 2019 (COVID-19), white blood cell (WBC) abnormalities have been found worldwide with significant inter-regional differences. In the present study, we evaluated WBC parameters concerning COVID-19 positivity and severity.
Methods: In this cross-sectional study, total WBC count, absolute count of each type of WBC, neutrophil to lymphocyte ratio (NLR), and lymphocyte to monocyte ratio (LMR) were compared between 150 COVID-19 patients and 150 non-COVID-19 patients presenting with COVID-19-like symptoms. Also, COVID-19 patients were divided into severe and non-severe cases.
Results: The severity of the disease had no significant association with age or gender (p>0.05). Total WBC count, absolute neutrophil count, absolute monocyte count, and NLR were significantly lower (p<0.05), while LMR was significantly higher in COVID-19 patients compared to non-COVID-19 patients (p<0.05). Total WBC count, absolute neutrophil count, and NLR were significantly higher (p<0.05), while absolute eosinophil count and absolute lymphocyte count were significantly lower (p<0.05) in severe COVID-19 patients compared to non-severe patients.
Conclusions: Age is not a predictive factor for the severity of COVID-19. Routine WBC parameters are useful in predicting the severity of the disease in COVID-19 patients and can be used as prognostic indicators. Routine WBC parameters can also be used for repeat RT-PCR testing in COVID-19 suspected patients.

Association of Acute Phase Reactants with COVID-19-related Severity and Mortality: A Study in a Tertiary Care Hospital in India

Seema Bijjaragi

Background: The outbreak of coronavirus disease 2019 (COVID-19) has become a public health emergency. This study aimed to investigate a possible correlation between COVID-19 severity and mortality and serum levels of ferritin and C-reactive protein (CRP).
Methods: This retrospective descriptive study was conducted on 75 COVID-19 patients hospitalized in a tertiary care hospital in Central Karnataka (India) from April 2021 to June 2021. Demographic details as well as clinical and laboratory parameters were retrieved from hospital records.
Results: Of 75 patients, 50 were survivors and 25 were non-survivors. Serum ferritin levels were significantly associated with mortality (p<0.040). There was no significant association between CRP level and COVID-19 severity or mortality (p>0.05).
Conclusion: This study revealed that serum ferritin levels can be used as a prognostic marker for COVID-19 patients.

Clinico-Hematological Profile of COVID-19 Patients: A Perspective of the Indian Scenario

Shuchi Smita

Background: The coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2, a newly emergent coronavirus, first recognized in Wuhan, China in December 2019. Early identification of laboratory indicators helps in distinguishing severe patients from mild to moderate counterparts and can facilitate medical interventions, thereby lowering the mortality rate. The present study was done to evaluate the role of hematological parameters and basic coagulation parameters in the assessment of the severity of COVID-19.
Methods: This retrospective observational study was done at a tertiary care institute from May 2020 to May 2021. Hematological and coagulation profile was studied in 200 confirmed COVID-19 cases. Data related to age, gender, and clinical features were retrieved from patients’ records. Laboratory findings such as complete blood count neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and coagulation parameters in different categories were compared.
Results: The majority of patients were males (59.5%) and with mild illness (52.5%). Moderate and severe illness was present in 30% and 17.5% of cases, respectively. The frequency of anemia, leucopenia, and thrombocytopenia was 62.5%, 6%, and 5.5%, respectively. Overall neutrophilia was seen in 40.5% of cases, whereas lymphopenia was seen in 39% of cases. Coagulation parameters were also much deranged in moderate and severe cases as compared to mild cases.
Conclusion: The hematopoietic and hemostatic systems are significantly affected by COVID-19. Careful evaluation of laboratory parameters assists clinicians in formulating a tailored treatment approach and in predicting disease severity.

Association between C-Reactive Protein Test Result and Clinical Characteristics in Patients with COVID-19

Haniyeh Sadat Fayazi

Background: In coronavirus disease 2019 (COVID-19), elevated serum levels of C-reactive protein (CRP), a marker of systemic inflammation, are commonly observed. We aimed to investigate the associations between CRP test results and clinical characteristics in patients with COVID-19.
Method: In this cross-sectional study, data from 399 patients with COVID-19 were collected through a census method. The patients were divided into a CRP-positive group (n=335) and a CRP-negative group (n=64). Demographical data, laboratory findings, clinical characteristics, and history of some underlying diseases were compared between the two groups. All analyses were carried out in SPSS (version 21).
Results: The frequency of hypertension was 40.1% among the study population, 42.4 % among CRP-positive patients, and 28.1% among CRP-negative patients. Diabetes and heart disease were the most common comorbidities among the patients. Dyspnea (60.4%), fever (52.7%), fatigue (45.4%), and dry cough (40.1%) were the most commonly observed symptoms. The mean duration of hospitalization was 8.14±6.18 days, and the mean duration of intensive care unit stay was 9.09±9.41 days. Moreover, CRP positivity was significantly associated with hypertension, immunosuppressive therapy, and higher duration of hospitalization (p<0.05).
Conclusion: Pre-existing hypertension, diabetes, and heart disease with the coincidence of some clinical symptoms are associated with higher levels of CRP in COVID-19 patients, which results in longer hospitalization.

Effective Binding Affinity of Inhibitor N-(3-(Carbamoylamino) Phenyl) Acetamide against the SARS-CoV-2 NSP13 Helicase

Rajneesh Prajapat

Background : The outbreak of coronavirus disease 2019 (COVID-19) has become a global health emergency. The severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) NSP13 helicase plays an important role in SARS-CoV-2 replication and could serve as a target for the development of antivirals. The objective of the study was to perform homology modeling and docking analysis of SARS-CoV-2 NSP13 helicase as a drug target.
Methods: The structure and function of SARS-CoV-2 NSP13 helicase were predicted by in-silico modeling studies. The SWISS-MODEL structure assessment tool was used for homology modeling and visual analysis of the crystal structure of the protein. The validation for structure models was performed using PROCHECK. Model quality was estimated based on the QMEAN and ProSA. The MCULE-1-Click docking and InterEvDock-2.0 server were used for protein-ligand docking.
Results: The SARS-CoV-2 NSP13 helicase model corresponded to probability confirmation with 90.9% residue of the core section, which highlights the accuracy of the predicted model. ProSA Z-score of -9.17 indicated the good quality of the model. Inhibitor N-(3-(carbamoylamino) phenyl) acetamide exhibited effective binding affinity against the NSP13 helicase. The docking results revealed that Lys-146, Leu-147, Ile-151, Tyr-185, Lys-195, Tyr-224, Val-226, Leu-227, Ser-229 residues exhibit good binding interactions with inhibitor ligand N-(3-(carbamoyl amino) phenyl) acetamide.
Conclusion: Hence, the proposed inhibitor could potently inhibit SARS-CoV-2 NSP13 helicase, which is thought to play key roles during viral replication. The results of this study indicate that N-(3-(carbamoylamino) phenyl) acetamide could be a valuable lead molecule with great potential for SARS-CoV-2 NSP13 helicase inhibition.

Evaluation of Absolute Neutrophil Count in COVID-19 Patients in a Tertiary Care Hospital

Harsha Jaykar

Background: Coronavirus disease 2019 (COVID-19) is a communicable disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The clinical manifestations of COVID-19 vary from asymptomatic to acute respiratory distress syndrome. In severely-ill patients, neutrophil count is significantly increased. This study aimed to evaluate absolute neutrophil count (ANC) in patients with COVID-19 and healthy individuals.
Methods: This retrospective, cross-sectional study was carried out on patients admitted to the outpatient department of OBGY Rural Hospital (Maharashtra, India) from April 2021 to June 2021. A peripheral venous blood sample (3 ml) was taken from 143 patients with COVID-19 and 143 healthy controls. The blood samples were analyzed using a fully automated blood cell counter for the estimation of complete blood count. A peripheral blood smear was prepared and stained with Leishman stain for evaluation of morphological changes.
Results: The ANC of COVID-19 patients was significantly higher than that of healthy control subjects (p=0.00001). Toxic granules (48.9%) were the most common morphological neutrophil abnormality, followed by hypolobation, hypogranulation, Pseudo-Pelger-Huet anomaly (20.9%), and shift to left with the presence of immature myeloid series cells.
Conclusion: High ANC along with morphological changes in neutrophils could be used as a simple and inexpensive surrogate marker of COVID-19 and its severity.

Anti-SARS-CoV-2 IgG Response after First and Second Dose of COVID-19 Vaccine

Vishwanath Patil

Background: Pandemics have serious adverse impacts on public health, economy, social structure, and overall growth and development of a nation. Such impacts can be mitigated by timely introduction of effective vaccination programs. This was successfully achieved in India. This study was performed to compare the anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG) responses after first and second dose of coronavirus disease 2019 (COVID-19) vaccination.
Methods: This cross-sectional study included 60 people who were vaccinated with the AstraZeneca vaccine at Karnataka Institute of Medical Sciences, Hubballi, India. The subjects were divided into two groups. Group I included 30 people who had received a single dose of the vaccine, and group II included 30 people who had received two doses of the vaccine. Exclusion criteria included having a history of influenza like illness/severe acute respiratory infection/proven COVID-19 infection in past 6 months. The antibody response was measured by the Anti-SARS-CoV-2 IgG test using the VITROS Anti-SARS-CoV-2 IgG Reagent Pack.
Results: We observed that 97% of the subjects had reactive IgG antibodies after receiving two doses of the vaccine, whereas only 83% of the subjects developed antibodies after a single dose of the vaccine. A positive correlation was observed between the development of reactive antibodies and the duration between the first dose and the second dose (r=0.24).
Conclusion: Based on the results, the two-dose vaccination with the AstraZeneca vaccine is beneficial over the single-dose vaccination for protection against COVID-19. Moreover, increasing the duration between doses might improve the antibody response.

Hypoplastic Acute Myeloid Leukemia in a COVID-19 Patient: A Diagnostic Dilemma(Case Report)

Shuchismita .

Hypocellular acute myeloid leukemia (AML) is an infrequent and challenging entity, and superinfection with coronavirus disease 2019 (COVID-19) could further complicate its diagnosis and management. It is characterized by low bone marrow cellularity, prominent cytopenias, and in many cases, clinically simulate aplastic anemia and hypoplastic myelodysplastic syndrome. We report a case of hypocellular AML-M2 in a 65-year-old male who was found to be COVID-19-positive. The cause of hypoplasia of bone marrow in such cases is still ambiguous and could be due to infiltration by blasts or co-infections. The cause of hypoplasia must be determined for proper management, which requires analysis of more such cases.