Results
The mean age of the whole cohort was 8.11±5.71years (4 months-17 years).
Thirty-five patients (50%) were male; of the 30 SARS-CoV-2 test
positive patients, 15 (50%) were male. In the whole cohort (n=70), the
most common presenting symptoms were fever (65.7%) and cough (60%). In
the SARS-CoV-2 test positive and negative groups, 17 (56.7%) and 19
negative patients (47.5%) had pneumonia, respectively. None of the
patients required treatment in the intensive care unit.
Complete blood count parameters of the SARS-CoV-2 test positive and
negative groups were given in Table 1. Six patients (20%) with
SARS-CoV-2 test positive and 11 patients (27.5%) with test negative
were anemic according to age-specific intervals. Of note, a SARS-CoV-2
test positive 14-year-old Afghan patient with a diagnosis of aplastic
anemia had pancytopenia before COVID-19.
The mean leukocyte counts of the SARS-CoV-2 test positive and negative
groups were 7.0±3.7x109/L and
10.4±7.1x109/L, respectively (p<0.05).
Within the SARS-CoV-2 test positive group, two patients (6.7%) had
leukocytosis and four patients (13.3%) had leukopenia, according to
age-specific intervals. The mean ALC of COVID-19 patients were
2.7±2.3x109/L; nine (30%) of them had lymphopenia,
according to age-specific intervals. Twelve patients (30%) in the
SARS-CoV-2 test negative group had also lymphopenia. The ALCs of
COVID-19 patients with and without pneumonia were
2.1±0.9x109/L and 3.4±2.9x109/L,
respectively (p<0.05). Reactive lymphocytes (Fig 1) were noted
in 85.1% of the peripheral smears of the whole cohort; these figures
were 77.8% and 90% in the SARS-CoV-2 test positive and negative
groups. The mean absolute reactive lymphocyte (ARL) counts of SARS-CoV-2
test positive and negative groups were, 0.7±0.7x109/L,
1.2±1.3x109/L, respectively (p<0.05). The
mean LUC counts of SARS-CoV-2 test positive and negative groups were
0.3±0.2x109/L and 0.2±0.23x109/L,
respectively (p>0.05). No correlation between LUC count and
ARL count was noted. The respective mean absolute neutrophil counts were
3.7±2.9 x109/L and 5.4±4.2 x109/L
(p<0.05). Four patients (13.3%) with SARS-CoV-2 test positive
and 10 patients (25%) with negative result groups had neutrophilia.
Seven (23.3%) COVID-19 patients had mild neutropenia, whereas 3 (7.5%)
patients with test negative had neutropenia. The mean
neutrophil/lymphocyte ratios of SARS-CoV-2 positive and negative groups
were 2.7±2.9 and 2.9±4.2, respectively (p>0.05). Immature
myeloid cells (>2% in blood smear) were noted in 13
children (23%) in the COVID-19 group. All COVID-19 patients’ DNI were
<0.4. The mean AMC was 0.4±0.3x109/L in the
SARS-CoV-2 positive and 0.6±0.5x109/L in the
SARS-CoV-2 negative patients (p<0.05). Leukoerythroblastic
reaction was not noted in any children in the whole cohort.
The mean platelet count was 268±89x109/L in the
SARS-CoV-2 positive and 339±178x109/L in the
SARS-CoV-2 negative group (p<0.05) (Table 1). In the whole
cohort, thrombocytopenia was detected in four patients; one of them was
the patient with aplastic anemia and COVID-19; the remaining three were
in the SARS-CoV-2 negative group. Thrombocytosis was noted in one
patient only. The mean platelet volume (MPV) was comparable between the
two groups; with no child noted to have increased MPV. The mean
C-reactive protein level of the SARS-CoV-2 positive group was
significantly lower when compared with that of SARS-CoV-2 negative group
(p=0.006).
In the peripheral smears of a few children affected by COVID-19,
vacuolated monocytes (n=3; 13.3%) and dysplastic changes such as
hypergranulation/lobulation abnormalities in neutrophils (n=11; 36.7%)
were noted (Figs. 2, and 3). The respective figures within the
non-COVID-19 group were 4 (10.0%) and 9 (22.5%). Although the MPV
values were within the normal range, 20% of the COVID-19 patients had
giant platelets (Figure 4); however, giant platelets were also noted in
27.5% of the negative patients.