Coronavirus disease 2019 induces multi‐lineage, morphologic changes in peripheral blood cells

Abstract The clinical course of coronavirus disease 2019 (COVID-19) varies from mild symptoms to acute respiratory distress syndrome, hyperinflammation, and coagulation disorder The hematopoietic system plays a critical role in the observed hyperinflammation, particularly in severely ill patients We conducted a prospective diagnostic study performing a blood differential analyzing morphologic changes in peripheral blood of COVID-19 patients COVID-19 associated morphologic changes were defined in a training cohort and subsequently validated in a second cohort (n = 45) Morphologic aberrations were further analyzed by electron microscopy (EM) and flow cytometry of lymphocytes was performed We included 45 COVID-19 patients in our study (median age 58 years;82% on intensive care unit) The blood differential showed a specific pattern of pronounced multi-lineage aberrations in lymphocytes (80%) and monocytes (91%) of patients Overall, 84%, 98%, and 98% exhibited aberrations in granulopoiesis, erythropoiesis, and thrombopoiesis, respectively Electron microscopy revealed the ultrastructural equivalents of the observed changes and confirmed the multi-lineage aberrations already seen by light microscopy The morphologic pattern caused by COVID-19 is characteristic and underlines the serious perturbation of the hematopoietic system We defined a hematologic COVID-19 pattern to facilitate further independent diagnostic analysis and to investigate the impact on the hematologic system during the clinical course of COVID-19 patients