ASPECTOS HEMATOLÓGICOS EM PACIENTES COM O VÀRUS DA COVID-19: UMA REVISÃO SISTEMÁTICA

Abstract

HEMATOLOGICAL ASPECTS IN PATIENTS WITH THE
COVID-19: A SYSTEMATIC REVIEW
DEISE A. A. PIRES OLIVEIRA 1
BEATRIZ SIQUEIRA SILVA 2
PROFESSOR OF THE MEDICAL COURSE AT THE EVANGELICAL UNIVERSITY OF ANÁPOLIS - UNIEVANG�LICA�¹
STUDENT OF THE MEDICAL COURSE AT THE EVANGELICAL UNIVERSITY OF ANÁPOLIS - UNIEVANG�LICA�²
INTRODUCTION
THE COVID-19 PANDEMIC HAS CAUSED A HEALTH CRISIS ON THE PLANET, WITH
THIS IS CAUSED BY A HIGHLY CONTAGIOUS VIRAL DISEASE, FIRST IDENTIFIED
ONCE IN CHINA IN 2019, WHICH LEFT, AND STILL HAS, MANY DEATHS AROUND THE WORLD.
WORLD, AND THE VIRUS THAT CAUSES THIS DISEASE, CALLED THE NEW CORONAVIRUS, IS A
VARIATION OF THE SARS-COV-2 VIRUS (SOUZA ET AL., 2021).
THE DISEASE CAUSED BY THE CORONAVIRUS, COVID-19, MANIFESTS ITSELF,
TYPICALLY AS A RESPIRATORY TRACT INFECTION, WHICH MAY AFFECT SEVERAL ORGANS
AND BODY SYSTEMS, INCLUDING THE HEMATOPOIETIC. THE DISEASE COURSE OF COVID-19
CAN OCCUR WITH THE INSTALLATION OF SERIOUS INFECTIONS, WHICH WILL CAUSE A RESPONSE
INFLAMMATION GREATER THAN NORMAL, WHICH MAY RESULT IN HEMATOLOGICAL CHANGES,
AMONG THEM THE HYPERCOAGULABILITY THAT CAN PRESENT ITSELF AS PART OF THE COAGULATION
DISSEMINATED INTRAVASCULAR DISEASE (DIC), THROMBOEMBOLIC EVENTS AND THE
MACROPHAGE ACTIVATION (FLEURY, 2020); (NICOLAU, 2020).
IN THE EVALUATION OF THE GENERAL CONDITION OF A PATIENT AFFECTED BY THE COVID 19 VIRUS, THE RESULTS OF HEMATOLOGICAL EXAMS ARE ESSENTIAL IN THE KNOWLEDGE OF THE
IMMUNOLOGICAL LEVELS OF THE PATIENT, WHICH DIRECTLY INTERFERES IN THE COURSE OF THE DISEASE.
ITS RESULTS CAN BE USED AS A PROGNOSTIC MARKER AND ALSO FOR
TREATMENT AND FOLLOW-UP OF THE PATIENT'S EVOLUTION (GIL ET AL., 2020). SO,
IT IS CLEAR THAT THE HEMATOLOGICAL FINDINGS ARE IMPORTANT FROM THE BEGINNING OF THE DISEASE,
ASSESSING WHETHER THE TREATMENT IS BEING EFFECTIVE, DESPITE THE FACT THAT THERE IS STILL NO TREATMENT
SPECIFIC, AS WELL AS IF THERE IS A NEED FOR EMERGENCY MEASURES. THEREFORE, DISCUSS
CIPEEX - INTERNATIONAL CONGRESS OF RESEARCH, TEACHING AND EXTENSION
V.3 (2022) - ISSN: 2596-1578
TWO
ASPECTS INVOLVING HEMATOLOGY IN COVID-19 IS EXTREMELY RELEVANT AND
IMPORTANCE (GIL ET AL., 2020).
IN GENERAL, THE MOST COMMON HEMATOLOGICAL CHANGES FOUND
IN COVID-19 ARE LYMPHOPENIA, LEUKOPENIA, NEUTROPENIA, LEUKOCYTOSIS, EOSINOPENIA,
DECREASED HEMOGLOBIN, THROMBOCYTOPENIA, PLATELET AGGREGATION, INCREASED D-DIMER,
PROTHROMBIN TIME (PT) AND ACTIVATED PARTIAL THROMBOPLASTIN TIME (APTT), BETWEEN
OTHERS, THESE ALTERATIONS BEING IMPORTANT PREDICTORS OF THE DISEASE AND ESSENTIAL IN THE
MONITORING OF CORONAVIRUS CASES (PEREIRA ET AL., 2021).
THUS, DESPITE THE DIFFICULTIES STILL ENCOUNTERED IN CONDUCTING THE CASES AND
TREATMENT, THE RESULTS OF HEMATOLOGICAL TESTS ARE ESSENTIAL IN THE EVALUATION OF
PROGNOSIS AND TREATMENT, THESE TESTS HAVING A DIRECT RELATIONSHIP WITH THE EFFECT THAT THE VIRUS
IT IS ABLE TO PROVOKE IN CELLS AND THROUGHOUT THE BODY (RUPPENTHAL ET AL., 2021).

MATERIALS AND METHODS
FOR THE DEVELOPMENT OF THE PRESENT WORK, A SEARCH WAS CARRIED OUT FOR THE
STUDIES THAT CONTEMPLATE THE THEME, WHICH WERE RESEARCHED AND SELECTED FOR
THIS REVIEW. STUDIES THAT ANALYZE THE PROFILE OF INVOLVEMENT WERE INCLUDED.
HEMATOLOGY OF PATIENTS WITH THE COVID-19 VIRUS, AS WELL AS THE
OVERVIEW OF THE COVID-19 PANDEMIC. THE ARTICLES WERE SELECTED IN THE DIFFERENT
AVAILABLE DATABASES SUCH AS SCIELO, PUBMED, GOOGLE SCHOLAR, DYNAMED AND
THEN THEY WERE ANALYZED SO THAT ALL MET THE INCLUSION CRITERIA
NEEDED. ALSO, THE PROJECT WAS SUBMITTED TO THE REGISTRATION OF THE PROSPERO PLATFORM, A
REGISTRY BASE OF SYSTEMATIC REVIEW PROTOCOLS, BEING APPROVED, WITH NUMBER
REGISTRATION CRD42022312844.
KEYWORDS: COVID-19; HEMATOLOGY; PANDEMIC
RESULTS
IT IS KNOWN THAT ALTHOUGH THE MAIN SITE OF INFECTION OF THE CORONAVIRUS IS THE
RESPIRATORY SYSTEM, THE DISEASE MANIFESTS SYSTEMIC CHARACTERISTICS, AMONG THEM,
IMPORTANT HEMATOLOGICAL CHANGES. THE EFFECT THAT THE VIRUS IS ABLE TO HAVE ON THE
HEMATOLOGICAL SYSTEM IS AN IMPORTANT GUIDE TO THE SEVERITY OF THE DISEASE. BETWEEN THE
POSSIBLE ALTERATIONS, THE MAIN AND MOST FREQUENT ARE LYMPHOPENIA, CONCOMITANT WITH
EXACERBATED PRODUCTION OF PRO-INFLAMMATORY CYTOKINES, DECREASED HEMOGLOBIN,
THROMBOCYTOPENIA, LYMPHOPENIA, INCREASED D-DIMER, PT AND APTT, WHICH
DEPENDING ON THE LEVEL OF CHANGE, ARE RELATED TO THE WORST OUTCOME OF THE INFECTION
(RUPPENTHAL ET AL., 2021).
AMONG THE HEMATOLOGICAL DISORDERS, THERE IS AN IMPORTANT ALTERATION OF THE
COAGULATION CASCADE, WHICH WAS OBSERVED MAINLY IN PATIENTS WITH
SEVERE DISEASE ONSET. (COELHO ET AL., 2021). AMONG THESE PARAMETERS,
INCREASED PT WAS OBSERVED IN SEVERE PATIENTS, WHILE MILDER CASES DID NOT
DEVELOPED CHANGES. IN THE CASE OF TTPA, ITS INCREASE WAS FOUND BOTH IN
MILD TO SEVERE CASES, AS WELL AS THE D-DIMER, WITH WORSENING OBSERVED IN THE LATTER.
AS THE PATIENT PROGRESSED TO MORE SEVERE DISEASE STATES. STILL, THE
ANALYSIS OF INFLAMMATORY PARAMETERS SHOWED THAT PATIENTS WITH WORSE OUTCOME
HAD INCREASED CRP (SILVA ET AL., 2022).
OF THE ALTERATIONS FOUND, THERE SEEMS TO BE AN ORDER OF INVOLVEMENT,
NEUTROPENIA BEING ONE OF THE FIRST ALTERATIONS FOUND, TOGETHER WITH THE
LYMPHOPENIA, BOTH RELATED TO INCREASED INFLAMMATION AND CYTOKINE PRODUCTION
INFLAMMATORY. FURTHERMORE, BOTH ALTERATIONS ARE RELATED TO THE SEVERITY OF THE DISEASE.
(REIS, FILHO, BORGES, 2022). HEMATOLOGICAL CHANGES ARE A CONSEQUENCE OF BOTH
DIRECT ACTION OF THE VIRUS ON CELLS, AS WELL AS INDIRECT (RUPPENTHAL ET AL., 2021).
STILL ON THE INFLAMMATORY ANALYSIS, HEMATOLOGICAL ANALYSIS IS ESSENTIAL IN THE
ASSESSMENT OF CHANGES THAT LEAD TO THE DEVELOPMENT OF SEPSIS (FLEURY 2020).
DEREGULATED CLOTTING MECHANISMS WERE RESPONSIBLE FOR CAUSING
THROMBOEMBOLIC COMPLICATIONS IN PATIENTS, WHICH IS A COMPLICATION
RELATIVELY COMMON OBSERVED IN PATIENTS WITH COVID-19 (COELHO ET AL.,
2021). IN ADDITION TO THE CHANGE IN PLATELET COUNT, CHANGES WERE OBSERVED IN
ITS MORPHOLOGY, MAINLY, GIANT PLATELETS, MORE COMMONLY IN PATIENTS
IN MORE SEVERE STAGES OF THE DISEASE (PEREIRA ET AL., 2021). STILL, THE CHANGES
THROMBOCYTOPENIC THROMBOSIS, BEING ALSO RELATED TO LONGER
HOSPITALIZATION OF PATIENTS (FLEURY 2020).
IN ADDITION TO THESE CHANGES, PATIENTS WHO DIED, FOR THE MOST PART,
STUDIED WITH EOSINOPHILIA, WHICH IS A FINDING THAT HELPS TO IDENTIFY THE EVOLUTION
OF DISEASE SEVERITY. LIKEWISE, ALTHOUGH IT WAS NOT A COMMON FINDING
IN PATIENTS, THOSE WITH HEMOGLOBIN VALUES �€‹�€‹LOWER THAN TEN, WITH
DEVELOPMENT OF ANEMIA, WERE MORE LIKELY TO DEVELOP
FOR A SEVERE CONDITION (PEREIRA ET AL., 2021). SEVERE GROUPS ALSO SHOWED
INCREASE IN RDW DUE TO BONE MARROW SUPPRESSION CAUSED BY THE VIRUS,
ALTERING THE MORPHOLOGY OF HEMATOLOGICAL LINEAGES. FURTHERMORE, THE HEMOGLOBIN
INFECTED PATIENTS, DEVELOPED A CHANGE IN THE HEME GROUP, WHICH CONTRIBUTES TO
THE WORSENING OF RESPIRATORY CONDITIONS (PEREIRA ET AL., 2021).
IN ADDITION TO THE CHANGES OBSERVED IN GENERAL, IT SHOULD BE NOTED THAT
THERE IS A WORSE OUTCOME OF THE DISEASE AND THE EVOLUTION OF THE HEMATOLOGICAL INVOLVEMENT IN
CERTAIN POPULATIONS, SUCH AS OLDER PATIENTS, WITH COMORBID
UNDERLYING CONDITIONS AND, STILL, A GREATER PREDOMINANCE OF SEVERITY IN PATIENTS OF THE SEX
MASCULINE. AMONG THE MOST COMMON COMORBIDITIES, HYPERTENSION WAS FOUND.
SYSTEMIC ARTERIAL DISEASE, TYPE 2 DIABETES MELLITUS AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE (REIS,
SON, BORGES, 2022).

CONCLUSION
LABORATORY HEMATOLOGICAL PROFILE DURING COVID-19 VIRUS INFECTION
IS IMPORTANT FOR THE PURPOSES OF PROGNOSIS AND TREATMENT OF THE DISEASE. IN THE REVIEW
SYSTEMATIC ANALYSIS OF HEMATOLOGICAL CHANGES, THE MOST EXPECTED IN PATIENTS WITH
COVID-19 INFECTION ARE LYMPHOPENIA, NEUTROPHILIA, THROMBOCYTOPENIA, AND CHANGES IN
INFECTIOUS PATTERN, SUCH AS INCREASED CRP AND D-DIMER. (REIS, SON, BORGES,
2022). IN GENERAL, THE UNDERSTANDING OF THE REPERCUSSION THAT THE DISEASE OF COVID 19 IS CAPABLE OF CAUSING IN THE HEMATOLOGICAL ASPECTS OF THE PATIENT, CORROBORATES THE
PROGNOSIS, TREATMENT AND EVEN PROPHYLAXIS OF CERTAIN CONDITIONS, BEING
MONITORING IS ESSENTIAL FOR A BETTER OUTCOME OF THE CASES (COELHO ET AL.,
2021).
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THANKS
I THANK THE RESEARCH, TEACHING AND EXTENSION CONGRESS AND THE
SCIENTIFIC INITIATION SCHOLARSHIPS FOR THE OPPORTUNITY AND COLLABORATION WITH THE PRESENT
WORK, I THANK THE GUIDING TEACHER AND THE ENTIRE EVALUATION BOARD.