{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T20:51:26Z","timestamp":1779915086640,"version":"3.53.1"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2020,12,3]],"date-time":"2020-12-03T00:00:00Z","timestamp":1606953600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,2,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To investigate the clinical significance of numeric and morphologic peripheral blood (PB) changes in coronavirus disease 2019 (COVID-19)\u2013positive patients in predicting the outcome, as well as to compare these changes between critically ill COVID-19\u2013positive and COVID-19\u2013negative patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The study included 90 COVID-19\u2013positive (51 intensive care unit [ICU] and 39 non-ICU) patients and 30 COVID-19\u2013negative ICU patients. We collected CBC parameters (both standard and research) and PB morphologic findings, which were independently scored by two hematopathologists.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>All patients with COVID-19 demonstrated striking numeric and morphologic WBC changes, which were different between mild and severe disease states. More severe disease was associated with significant neutrophilia and lymphopenia, which was intensified in critically ill patients. Abnormal WBC morphology, most pronounced in monocytes and lymphocytes, was associated with more mild disease; the changes were lost with disease progression. Between COVID-19\u2013positive and COVID-19\u2013negative ICU patients, significant differences in morphology-associated research parameters were indicative of changes due to the severe acute respiratory syndrome coronavirus 2 virus, including higher RNA content in monocytes, lower RNA content in lymphocytes, and smaller hypogranular neutrophils.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Hospitalized patients with COVID-19 should undergo a comprehensive daily CBC with manual WBC differential to monitor for numerical and morphologic changes predictive of poor outcome and signs of disease progression.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ajcp\/aqaa231","type":"journal-article","created":{"date-parts":[[2020,10,7]],"date-time":"2020-10-07T19:12:50Z","timestamp":1602097970000},"page":"364-375","source":"Crossref","is-referenced-by-count":86,"title":["Clinical Significance of CBC and WBC Morphology in the Diagnosis and Clinical Course of COVID-19 Infection"],"prefix":"10.1093","volume":"155","author":[{"given":"Olga","family":"Pozdnyakova","sequence":"first","affiliation":[{"name":"Department of Pathology, Brigham and Women\u2019s Hospital, Boston, MA"},{"name":"Division of Hematology, Department of Medicine, Brigham and Women\u2019s Hospital, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4100-7826","authenticated-orcid":false,"given":"Nathan T","family":"Connell","sequence":"additional","affiliation":[{"name":"Division of Hematology, Department of Medicine, Brigham and Women\u2019s Hospital, Boston, MA"},{"name":"Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1916-047X","authenticated-orcid":false,"given":"Elisabeth M","family":"Battinelli","sequence":"additional","affiliation":[{"name":"Division of Hematology, Department of Medicine, Brigham and Women\u2019s Hospital, Boston, MA"},{"name":"Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean M","family":"Connors","sequence":"additional","affiliation":[{"name":"Division of Hematology, Department of Medicine, Brigham and Women\u2019s Hospital, Boston, MA"},{"name":"Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoffrey","family":"Fell","sequence":"additional","affiliation":[{"name":"Department of Statistics, Dana Farber Cancer Institute, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annette S","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Pathology, Brigham and Women\u2019s Hospital, Boston, MA"},{"name":"Division of Hematology, Department of Medicine, Brigham and Women\u2019s Hospital, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,12,3]]},"reference":[{"key":"2021021117060507600_CIT0001","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1056\/NEJMoa2002032","article-title":"Clinical characteristics of coronavirus disease 2019 in China","volume":"382","author":"Guan","year":"2020","journal-title":"N Engl J Med."},{"key":"2021021117060507600_CIT0002","article-title":"COVID-19 infection induces readily detectable morphological and inflammation-related phenotypic changes in peripheral blood monocytes.","author":"Zhang","year":"2020","journal-title":"J Leukocyte Biol"},{"key":"2021021117060507600_CIT0003","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1002\/ajh.25834","article-title":"Plasmacytoid lymphocytes in SARS-CoV-2 infection (Covid-19)","volume":"95","author":"Foldes","year":"2020","journal-title":"Am J Hematol."},{"key":"2021021117060507600_CIT0004","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1002\/ajh.25793","article-title":"Leukoerythroblastic reaction in a patient with COVID-19 infection","volume":"95","author":"Mitra","year":"2020","journal-title":"Am J Hematol."},{"key":"2021021117060507600_CIT0005","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1002\/ajh.25824","article-title":"Morphological anomalies of circulating blood cells in COVID-19","volume":"95","author":"Zini","year":"2020","journal-title":"Am J Hematol."},{"key":"2021021117060507600_CIT0006","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1093\/ajcp\/aqaa108","article-title":"Peripheral blood examination findings in SARS-CoV-2 infection","volume":"154","author":"Nazarullah","year":"2020","journal-title":"Am J Clin Pathol."},{"key":"2021021117060507600_CIT0007","first-page":"211","article-title":"Infectious mononucleosis","volume":"390","author":"Dunmire","year":"2015","journal-title":"Curr Top Microbiol Immunol."},{"key":"2021021117060507600_CIT0008","doi-asserted-by":"crossref","first-page":"157","DOI":"10.4066\/AMJ.2012.100","article-title":"Haematological changes in HIV infection with correlation to CD4 cell count","volume":"5","author":"Parinitha","year":"2012","journal-title":"Australas Med J."},{"key":"2021021117060507600_CIT0009","doi-asserted-by":"crossref","DOI":"10.1056\/NEJMc2010419","article-title":"Clinical characteristics of Covid-19 in New York City","author":"Goyal","year":"2020;382:2372-2374","journal-title":"N Engl J Med."},{"key":"2021021117060507600_CIT0010","first-page":"E131","article-title":"Hematologic parameters in patients with COVID-19 infection","volume":"95","author":"Fan","year":"2020","journal-title":"Am J Hematol."},{"key":"2021021117060507600_CIT0011","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1515\/cclm-2020-0369","article-title":"Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis","volume":"58","author":"Henry","year":"2020","journal-title":"Clin Chem Lab Med."},{"key":"2021021117060507600_CIT0012","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1515\/cclm-2020-0377","article-title":"The hemocyte counts as a potential biomarker for predicting disease progression in COVID-19: a retrospective study","volume":"58","author":"Zheng","year":"2020","journal-title":"Clin Chem Lab Med."},{"key":"2021021117060507600_CIT0013","doi-asserted-by":"crossref","first-page":"m1091","DOI":"10.1136\/bmj.m1091","article-title":"Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study","volume":"368","author":"Chen","year":"2020","journal-title":"BMJ."},{"key":"2021021117060507600_CIT0014","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.1007\/s00277-020-04103-5","article-title":"Hematological findings in coronavirus disease 2019: indications of progression of disease","volume":"99","author":"Liu","year":"2020","journal-title":"Ann Hematol."},{"key":"2021021117060507600_CIT0015","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.7150\/ijms.46614","article-title":"Factors associated with death outcome in patients with severe coronavirus disease-19 (COVID-19): a case-control study","volume":"17","author":"Pan","year":"2020","journal-title":"Int J Med Sci."},{"key":"2021021117060507600_CIT0016","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1016\/j.ijid.2020.07.003","article-title":"Dynamic changes in peripheral blood lymphocyte subsets in adult patients with COVID-19","volume":"98","author":"Deng","year":"2020","journal-title":"Int J Infect Dis."},{"key":"2021021117060507600_CIT0017","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1016\/S0140-6736(20)30628-0","article-title":"COVID-19: consider cytokine storm syndromes and immunosuppression","volume":"395","author":"Mehta","year":"2020","journal-title":"Lancet."},{"key":"2021021117060507600_CIT0018","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1309\/AJCP4ZDKJ4ICOUAT","article-title":"Hemophagocytic lymphohistiocytosis: an update on diagnosis and pathogenesis","volume":"139","author":"Rosado","year":"2013","journal-title":"Am J Clin Pathol."},{"key":"2021021117060507600_CIT0019","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1136\/jclinpath-2015-203577","article-title":"The diagnosis of adult-onset haemophagocytic lymphohistiocytosis: lessons learned from a review of 29 cases of bone marrow haemophagocytosis in two large academic institutions","volume":"69","author":"Rosado","year":"2016","journal-title":"J Clin Pathol."},{"key":"2021021117060507600_CIT0020","article-title":"Morphology of COVID-19\u2013affected cells in peripheral blood film","volume":"13:e236117","author":"Singh","year":"2020","journal-title":"BMJ Case Rep."},{"key":"2021021117060507600_CIT0021","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1038\/s41392-020-0159-1","article-title":"Correction: lymphopenia predicts disease severity of COVID-19: a descriptive and predictive study","volume":"5","author":"Tan","year":"2020","journal-title":"Signal Transduct Target Ther."},{"key":"2021021117060507600_CIT0022","doi-asserted-by":"crossref","first-page":"102537","DOI":"10.1016\/j.autrev.2020.102537","article-title":"The role of cytokines including interleukin-6 in COVID-19 induced pneumonia and macrophage activation syndrome-like disease","volume":"19","author":"McGonagle","year":"2020","journal-title":"Autoimmun Rev."},{"key":"2021021117060507600_CIT0023","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1038\/82763","article-title":"IL-6 switches the differentiation of monocytes from dendritic cells to macrophages","volume":"1","author":"Chomarat","year":"2000","journal-title":"Nat Immunol."},{"key":"2021021117060507600_CIT0024","doi-asserted-by":"crossref","first-page":"188","DOI":"10.3389\/fimmu.2019.00188","article-title":"Variations in the phagosomal environment of human neutrophils and mononuclear phagocyte subsets","volume":"10","author":"Foote","year":"2019","journal-title":"Front Immunol."},{"key":"2021021117060507600_CIT0025","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.virusres.2004.09.004","article-title":"SARS-coronavirus replication in human peripheral monocytes\/macrophages","volume":"107","author":"Yilla","year":"2005","journal-title":"Virus Res."},{"key":"2021021117060507600_CIT0026","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1111\/ijlh.12562","article-title":"New parameters on the hematology analyzer XN-10 (SysmexTM) allow to distinguish childhood bacterial and viral infections","volume":"39","author":"Henriot","year":"2017","journal-title":"Int J Lab Hematol."},{"key":"2021021117060507600_CIT0027","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1016\/j.chest.2017.05.039","article-title":"Improved early detection of sepsis in the ED with a novel monocyte distribution width biomarker","volume":"152","author":"Crouser","year":"2017","journal-title":"Chest."},{"key":"2021021117060507600_CIT0028","doi-asserted-by":"crossref","DOI":"10.1515\/cclm-2020-0417","article-title":"Monocyte distribution width (MDW) as a screening tool for sepsis in the emergency department","author":"Agnello","year":"2020;58:1951-1957","journal-title":"Clin Chem Lab Med."}],"container-title":["American Journal of Clinical Pathology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ajcp\/article-pdf\/155\/3\/364\/36239575\/aqaa231.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ajcp\/article-pdf\/155\/3\/364\/36239575\/aqaa231.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,2,12]],"date-time":"2021-02-12T21:09:18Z","timestamp":1613164158000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajcp\/article\/155\/3\/364\/6017543"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12,3]]},"references-count":28,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2020,12,3]]},"published-print":{"date-parts":[[2021,2,11]]}},"URL":"https:\/\/doi.org\/10.1093\/ajcp\/aqaa231","relation":{},"ISSN":["0002-9173","1943-7722"],"issn-type":[{"value":"0002-9173","type":"print"},{"value":"1943-7722","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,3,1]]},"published":{"date-parts":[[2020,12,3]]}}}