Abstract

Objective: Many studies have detailed the mechanisms of infection and quantitative peripheral blood findings reported in severe acute respiratory syndrome virus 2 (SARS-CoV-2) patients during the severity of infection since the start of the coronavirus disease 2019 (COVID-19) pandemic. Though, only a few studies have described blood morphologic abnormalities. We report peripheral blood cells morphologic changes in convalescent patient.

Design: We performed complete blood counts (CBC), and blood smear of 52-year-old patient who were COVID-19 positive test by (RT-PCR), from May 20, 2021, through June 15, 2021. The peripheral blood smears of a convalescent patient were collected the morphological structures of Leukocytes, red blood cells (RBCs) and platelets were examined and documented, after 3 weeks from infection with COVID-19 RT-PCR was negative to look for viral changes on blood cells morphology.

Results: On a complete blood count (CBC), the most common quantitative hematologic abnormalities were mild anemia with RBCs showed no abnormality followed by WBCs normal in count, and relative lymphopenia. Neutrophils showed the most substantial morphologic alterations with C-shaped bi-lobulated nuclei, coarse toxic granulations and cytoplasmic vacuolization. Activated neutrophil granulocytes with elongated cell membrane, pseudo Pelger–Huët anomaly-like nuclei, ring form nuclei and pyknotic nucleus. Lymphocytes were atypical reactive lymphocytes with cytoplasmic pseudopod formation. Plasmacytoid lymphocytes with an eccentric nucleus and deeply basophilic cytoplasm are frequently seen. Monocytes seen in active form with cytoplasmic vacuolization and cytoplasm contain granules, with pseudopod formation. Platelets were adequate in number with giant platelets are occasionally seen. Smudge cell is also seen. RBCs were normocytic; normochromic.

Conclusion: Our work identifies and characterizes significant morphologic abnormalities in recovered COVID-19 patients' peripheral blood cells. Understanding these morphologic changes, in addition to established hematologic parameters, can help follow with COVID-19 patient during recovery through serial CBC and peripheral smear examination. Serial complete blood count and blood film review may become an essential tool to help physicians allocate patients to risk categories based on morphological findings if these proposals are supported by large-scale investigations of convalescent patients.

Keywords:

SARS-CoV-2 –Morphology – WBCs -  Abnormality - Case report

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