Alterações hematológicas em pacientes com COVID-19: uma revisão integrativa da literatura
Palavras-chave:
COVID-19, SARS-CoV-2, coronavírus, alterações hematológicas.Resumo
O SARS-CoV-2 é um vírus de RNA fita simples positiva, causador da Doença do Coronavírus (COVID-19). A principal proteína do seu invólucro viral é a proteína S (do inglês Spike) que é a responsável pela ligação do vírus ao seu receptor (enzima conversora de angiotensina 2 – ACE2). O principal sítio de infecção pelo SARS-CoV-2 é o sistema respiratório, mas a COVID-19 apresenta características multissistêmicas, podendo impactar também no sistema hematológico. Através de uma revisão integrativa de literatura, o objetivo deste estudo foi descrever as alterações hematológicas em pacientes com COVID-19. A maioria dos pacientes possuía idade acima dos 50 anos e era do sexo masculino, e as principais alterações hematológicas em pacientes com COVID-19 são diminuição de hemoglobina, neutrofilia, linfopenia, trombocitopenia, aumento de D-dímero, TP e TTPA e estas alterações tem sido associadas ao pior prognóstico, internação em UTI e óbitos. As alterações constatadas podem ser derivadas de efeito direto ou indireto do vírus nas células, mas todas necessitam de mais pesquisas para comprovação. A partir da relação entre os resultados dos exames hematológicos e o prognóstico que este implica, o tratamento para os pacientes se torna mais específico e efetivo.
Downloads
Referências
Liu Y, Kuo R, Shih S. COVID-19: The first documented coronavirus pandemic in history. Biomedical Journal, Taiwan, 2020; 43(4): 328-333. https://doi.org/10.1016/j.bj.2020.04.007
World Health Organization. Coronavirus Disease (COVID-19) Dashboard., 2020. https://covid19.who.int/
Shereen M, Khan S, Kazmi A, Bashir N, Siddique R. COVID-19 infection: origin, transmission, and characteristics of human coronaviruses. Journal of Advanced Research, Cairo, 2020; 24:91-98. https://doi.org/10.1016/j.jare.2020.03.005
Yesudhas D; Srivastava A, Gromiha M. COVID-19 outbreak: history, mechanism, transmission, structural, studies and therapeutics. Springer Nature, Alemanha, 2020; 49:199-213. https://doi.org/10.1007/s15010-020-01516-2
Shi Y, Wang G, Cai X, Deng J, Zheng L, Zhu H, et al. An overview of COVID-19. Journal of Zhejiang University (Biomedicine e Biotechnology), China, 2020; 21:343-360. https://doi.org/10.1631/jzus.B2000083
Grunewald S. Manifestações hematológicas na COVID-19. ELSEVIER, 2020; 42(S2). https://doi.org/10.1016/j.htct.2020.10.734
Terpos E, Stathopoulos I, Elalamy I, Kastritis E, Sergentanis T, Politou M, et al. Hematological findings and complications of COVID-19. Wiley Periodicals, 2020; 95(7):834-847. https://doi.org/10.1002/ajh.25829
Paramo J. Respuesta inflamatoria em relación com COVID-19 y otros denotipos protrombóticos. Reumatologia Clínica México, 2020. https://doi.org/10.1016/j.reuma.2020.06.004
Mertoglu C, Huyut M, Arslan Y, Ceylan Y, Coban T. How do routine laboratory tests change in coronavirus disease 2019?. Scandinavian Journal of Clinical and Laboratory Investigation, 2020; 81 (1): 24-33. https://doi.org/10.1080/00365513.2020.1855470
Yuan X, Huang W, Ye B, Chen C, Huang R, Wu F, et al. Changes of hematological and immunological parameters in COVID 19 patients. International Journal of Hematology, 2020. https://doi.org/10.1007/s12185-020-02930-w
Wang C, Deng R, Gou L, Fu Z, Zhang X, Shao F, et al. Preliminary study to identify severe from moderate cases of COVID-19 using combined hematology parameters. Annals of Translational Medicine, 2020; 8(9):1-15. https://doi.org/10.21037/atm-20-3391
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Elsevier,2020; 395:497-506. https://doi.org/10.1016/ S0140-6736(20)30183-5
Chen N, Zhou M, Dong X, Qu J, Gang F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Elsevier, 2020; 395:507-513. https://doi.org/10.1016/ S0140-6736(20)30211-7
Mousavi S, Rad S, Rostami T, Rostami M, Mousavi S, Mirhoseini S, et al. Hematologic predictors of mortality in hospitalized patients with COVID-19: a comparative study. Hematology, 2020; 25(1):383-388. https://doi.org/10.1080/16078454.2020.1833435
Liao D, Zhou F, Luo L, Xu M, Wang H, Xia J, et al. Haematological characteristics and risk factors in the classification and prognosis evaluation of COVID-19: a retrospective cohort study. Elsevier, 2020; 7:671-678. https://doi.org/10.1016/ S2352-3026(20)30217-9
Fu J, Kong J, Wang W, Wu M, Yao L, Wang Z, et al. The clinical implication of dynamic neutrophil to lymphocyte ratio and D-dimer in COVID-19: A retrospective study in Suzhou China. Elsevier, 2020; 192:3-8. https://doi.org/10.1016/j.thromres.2020.05.006
Bergamaschi G, Andreis F, Aronico N, Lenti M, Barteselli C, Merli S, et al. Anemia in patients with Covid 19: pathogenesis and clinical signifcance. Clinical and Experimental Medicine, 2021; https://doi.org/10.1007/s10238-020-00679-4
Araya S, Wordofa M, Mamo M, Tsegay Y, Hordofa A, Negesso A, et al. The Magnitude of Hematological Abnormalities Among COVID-19 Patients in Addis Ababa, Ethiopia. Journal of Multidisciplinary Healthcare, 2021; 14:545-554. https://doi.org/10.2147/JMDH.S295432
Taneri P, Ochoa S, Llanaj E, Raguindin P, Rojas L, Diaz Z, et al. Anemia and iron metabolism in COVID-19: a systematic review and meta-analysis. European Journal of Epidemiology, 2020; 35:763-773. https://doi.org/10.1007/s10654-020-00678-5
Zhou F, Yu T, Du R, Fan G, Liu Y, Xiang J, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Elsevier, 2020; 395:1054-1062. https://doi.org/10.1016/ S0140-6736(20)30566-3
Pirsalehi A, Salari S, Baghestani A, Sanadgol G, Shirin D, Baerz M, et al. Differential alteration trend of white blood cells (WBCs) and monocytes count in severe and non-severe COVID-19 patients within a 7-day follow-up. Iranian Journal of Microbiology, 2020; 13(1):8-16, 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8043835/
Liang J, Nong S, Jiang L, Chi X, Bi D, Cao J, et al. Correlations of disease severity and age with hematology parameter variations in patients with COVID-19 pre- and post- treatment. Wiley Periodicals LLC, 2020; 35 (1). https://doi.org/10.1002/jcla.23609
Ghaith M, Albanghali M, Aldari A, Iqbal M, Almaimani R, AlQuthami K, et al. Potential Predictors of Poor Prognosis among Severe COVID-19 Patients: A Single-Center Study. Canadian Journal of Infectious Diseases and Medical Microbiology, 2021. https://doi.org/10.1155/2021/6656092
Luke F, Orso E, Kirsten J, Poeck H, Grube M, Wolff D, et al. Coronavirus disease 2019 induces multi-lineage, morphologic changes in peripheral blood cells. British Society for Haematology and John Wiley & Sons Ltd, 2020. https://doi.org/10.1002/jha2.44
Ding X, Yu Y, Lu B, Huo J, Chen M, Kang Y, et al. Dynamic profile and clinical implications of hematological parameters in hospitalized patients with coronavirus disease 2019. Clin Chem Lab Med, 2020; 58(8):1365-1371. https://doi.org/10.1515/cclm-2020-0411
Bao C, Tao X, Cui W, Yi B, Pan T, Young K, et al. SARS-CoV-2 induced thrombocytopenia as an important biomarker signifcantly correlated with abnormal coagulation function, increased intravascular blood clot risk and mortality in COVID-19 patients. Experimental Hematology & Oncology, 2020; 9:16. https://doi.org/10.1186/s40164-020-00172-4
Chen R, Sang L, Jiang M, Yang Z, Jia N, Fu W, et al. Longitudinal hematologic and immunologic variations associated with the progression of COVID-19 patients in China. Elsevier, 2020; 146 (1):89-100. https://doi.org/10.1016/j.jaci.2020.05.003
Li L, Yang L, Gui S, Pan F, Ye T, Liang B, et al. Association of clinical and radiographic findings with the outcomes of 93 patients with COVID-19 in Wuhan, China. Theranostics, 2020; 10 (14):6113-6121. https://doi.org/10.7150/thno.46569
Arcanjo A, Logullo J, Menezes C, Giangiarulo T, Reis M, Castro G, et al. The emerging role of neutrophil extracellular traps in severe acute respiratory syndrome coronavirus 2 (COVID 19). Scientific Reports, 2020; 10:19630. https://doi.org/10.1038/s41598-020-76781-0
Wang F, Hou H, Luo Y, Tang G, Wu S, Huang M, et al. The laboratory tests and host immunity of COVID-19 patients with different severity of illness. JCL Insight, 2020. https://doi.org/10.1172/jci. insight.137799
Jibrian Y, Okwong O, Maigari I, Dunga J, Ballah A, Umar M, et al. Clinical and laboratory characteristics of COVID-19 among adult patients admitted to the isolation centre at Abubakar Tafawa Balewa Teaching Hospital Bauchi, Northeast Nigeria. Pan African Medical Journal, 2020; 37(1). https://doi.org/10.11604/pamj.supp.2020.37.1.26162
Kaur G, Sandeep F, Olayinka O, Gupta G. Morphologic Changes in Circulating Blood Cells of COVID-19 Patients. Cureus, 2021; 13(2). https://doi.org/10.7759/cureus.13416
Berber I, Cagasar O, Sarici A, Berber N, Ismet A, Olutas O, et al. Peripheral Blood Smear Findings of COVID-19 Patients Provide İnformation about the Severity of the Disease and the Duration of Hospital Stay. Mediterranean Journal of Hematology and Infectious Diseases, 2021; 13(1):1-10. http://dx.doi.org/10.4084/MJHID.2021.009
Lombardi A, Trombetta E, Cattaneo A, Castelli V, Palomba E, Tirone M, et al. Early phases of COVID-19 are characterized by a reduction in lymphocyte populations and the presence of atypical monocytes. Frontiers in Immunology, 2020; 11. https://doi.org/10.3389/fimmu.2020.560330
Zhang W, Zhang Z, Ye Y, Luo Y, Pan S, Qi H, et al. Lymphocyte percentage and hemoglobin as a joint parameter for the prediction of severe and nonsevere COVID-19: a preliminary study. Annals of Translational Medicine, 2020; 8(19):1-10. http://dx.doi.org/10.21037/atm-20-6001
Wang Z, Yang B, Li Q, Wen L, Zhang R. Clinical Features of 69 Cases with Coronavirus Disease 2019 in Wuhan, China. Oxford University Press for the Infectious Diseases Society of America, 2020. https://pubmed.ncbi.nlm.nih.gov/32176772/
Qian G, Yang N, Ding F, Ma A, Wang Z, Shen Y, et al. Epidemiologic and clinical characteristics of 91 hospitalized patients with COVID-19 in Zhejiang, China: a retrospective, multi-centre case series. International Journal of Medicine, 2020; 474-481. https://doi.org/10.1093/qjmed/hcaa089
Fan B, Chong V, Chan S, Lim G, Lim K, Bee G, et al. Hematologic parameters in patients with COVID-19 infection. Wiley Periodicals, 2020; 95:131-134. https://doi.org/10.1002/ajh.25774
Pilaczynska-Cemel M, Golda R, Dabrowska A, Przybylski G. Analysis of the level of selected parameters of inflammation, circulating immune complexes, and related indicators (neutrophil/ lymphocyte, platelet/lymphocyte, CRP/CIC) in patients with obstructive diseases. Central European Journal of Immunology, 2019; 44(3):292-298. https://doi.org/10.5114/ceji.2019.87498
O’Shea A, Parakh A, Hedgire S, Lee S. Multisystem Assessment of the Imaging Manifestations of Coagulopathy in Hospitalized Patients With Coronavirus Disease (COVID-19). AJR, 2021; 216:1088-1098. https://doi.org/10.2214/AJR.20.24132
Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. International Society on Thrombosis and Haemostasis, 2020; 18:844-847. https://doi.org/10.1111/jth.14768
Wang X, Du B, Li J, Wang S, Wang X, Guo M, et al. D-dimer surge and coagulation disorders in COVID-19 related pneumonia patients with cardiac injury. Medicine, 2020; 99(31). http://dx.doi.org/10.1097/MD.0000000000021513
Friedrich M, Studt J, Braun J, Spahn D, Kaserer A. Coronavirus-induced coagulopathy during the course of disease. Plos One, 2020. https://doi.org/10.1371/ journal.pone.0243409
Schimitt F, Manolov V, Morgenstern J, Fleminh T, Heitmeier S, Uhle F, et al. Acute fbrinolysis shutdown occurs early in septic shock and is associated with increased morbidity and mortality: results of an observational pilot study. Annals of Intensive Care, 2019. 9:1-15. https://doi.org/10.1186/s13613-019-0499-6
Gupta N, Zhao Y, Evans C. The stimulation of thrombosis by hypoxia. ELSEVIER, 2019; 181:77-83. Disponível em: https://doi.org/10.1016/j.thromres.2019.07.013
Levi M, Poll T. Coagulation and sepsis. ELSEVIER, 2017; 149:28-44. https://doi.org/10.1016/j.thromres.2016.11.007
Iba T, Levy J, Warkentin T, Tchachil J, Poll T, Levi M, et al. Diagnosis and management of sepsis-induced coagulopathy and disseminated intravascular coagulation. Jounal of Thrombosis and Haemostasis, 2019; 17:1989-1994. https://doi.org/10.1111/jth.14578
Li T, Wang X, Zhuang X, Wang H, Li A, Huang L, et al. Baseline characteristics and changes of biomarkers in disease course predict prognosis of patients with COVID 19. Internal and Emergency Medicine, 2020. https://doi.org/10.1007/s11739-020-02560-4
Pan F, Yang L, Li Y, Liang B, Li L, Ye T, et al. Factors associated with death outcome in patients with severe coronavirus disease-19 (COVID-19): a case-control study. International Journal of Medical Sciences, 2020; 17(9):1281-1292. https://doi.org/10.7150/ijms.46614
Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA, 2020; 323(11):1061-1069. https://doi.org/10.1001/jama.2020.1585
Han H, Yang L, Liu R, Liu F, Wu K, Li J, et al. Prominent changes in blood coagulation of patients with SARS-CoV-2 infection. Clin Chem Lab Med, 2020; 58(7):1116-1120. https://doi.org/10.1515/cclm-2020-0188
Bg S, Gosavi S, Rao A, Shastry S, Raj S, Sharma A, et al. Neutrophil-to-Lymphocyte, Lymphocyte-toMonocyte, and Platelet-to-Lymphocyte Ratios: Prognostic Significance in COVID-19. Cureus, 2021; 13 (1). https://doi.org/10.7759/cureus.12622
Qu R, Ling Y, Zhang Y, Wei L, Chen X, Li X, et al. Platelet‐to‐lymphocyte ratio is associated with prognosis in patients with coronavirus disease‐19. Wiley Periodicals, 2020; 1-9. https://doi.org/10.1002/jmv.25767
Merza M, Mezori A, Mohammed H, Abdulah D. COVID-19 outbreak in Iraqi Kurdistan: The first report characterizing epidemiological, clinical, laboratory, and radiological findings of the disease. Elsevier, 2020; 14:547-554. https://doi.org/10.1016/j.dsx.2020.04.047
Downloads
Publicado
Como Citar
Edição
Seção
Licença
Direito autoral (Copyright): todo o conteúdo do periódico, exceto onde está identificado, está licenciado sob uma Licença Creative Commons Atribuição-NãoComercial-SemDerivações 4.0 Internacional (CC BY-NC-ND 4.0) https://creativecommons.org/licenses/by-nc-nd/4.0/deed.pt_BR/.
A Declaração de Direito Autoral e os itens a serem observados podem ser visualizados abaixo:
1. Política para Periódicos de Acesso Livre
Autores que publicam nesta revista concordam com os seguintes termos:
a) Autores mantém os direitos autorais e concedem à revista o direito de primeira publicação, com o trabalho simultaneamente licenciado sob a Licença Creative Commons Attribution que permite o compartilhamento do trabalho com reconhecimento da autoria e publicação inicial nesta revista.
b) Autores têm autorização para assumir contratos adicionais separadamente, para distribuição não-exclusiva da versão do trabalho publicada nesta revista (ex.: publicar em repositório institucional ou como capítulo de livro), com reconhecimento de autoria e publicação inicial nesta revista.
c) Autores têm permissão e são estimulados a publicar e distribuir seu trabalho online (ex.: em repositórios institucionais ou na sua página pessoal) a qualquer ponto antes ou durante o processo editorial, já que isso pode gerar alterações produtivas, bem como aumentar o impacto e a citação do trabalho publicado (Veja O Efeito do Acesso Livre).
Todo o conteúdo do periódico, exceto onde está identificado, está licenciado sob uma Licença Creative Commons Atribuição-NãoComercial-SemDerivações 4.0 Internacional (CC BY-NC-ND 4.0) https://creativecommons.org/licenses/by-nc-nd/4.0/deed.pt_BR/.
