Morphological changes in a case of SARS-CoV-2 infection.

An 81-year-old man presented with shortness of breath, fever, hypoxia, and widespread diffuse infiltrates on a chest radio-graph Oral swab testing was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2;RNA reverse transcriptase–polymerase chain reaction RdRp gene) Despite therapy with oxygen and antibiotics, the patient deteriorated and required ventilator support Comorbidities included hypertension, chronic renal disease, and restrictive lung disease A blood film was prepared upon transfer to intensive care, 48 hours prior to death Laboratory parameters at that time were: hemoglobin, 90 g/L;neutrophils, 2 78 3 109/L;lymphocytes, 1 06 3 109/L;monocytes, 2 5 3 109/L;and platelets, 44 3 109/L Inflammatory markers linked to poor outcome rose during the admission with C-reactive protein reaching 406 mg/L and troponin reaching 1852 ng/L The blood film (panels A-N;original magnification 31000 for all panels;May-Grunwald–Giemsa stain) revealed: increased pleomorphic (panel A) and vacuolated monocytes (panels B-C);leukoerythroblastic features (panels D-E);nucleated red cells with dyserythropoiesis/basophilic stippling (panel F);lymphopenia, some with cytoplasmic vacuolation (panels G-H);lymphoplasmacytoid lymphocytes (panels I-J);an occasional plasma cell (panel K arrow);thrombocytopenia, giant platelets (panels L-M);and a circulating megakaryocyte (panel N)