Association of Thrombocytopenia and C-reactive Protein in COVID-19 Patients Attending a Tertiary Care Hospital
Keywords:
Thrombocytopenia, Bleeding, C Reactive, COVID-19Abstract
OBJECTIVE: This study evaluates the frequency and relationship between Thrombocytopenia and CRP levels in Covid-19 patients.
METHODOLOGY: The cross-sectional retrospective study was conducted at Dr. Ishrat ul Ebad Khan Institute of Blood Diseases from October 2021 to September 2022. Data was collected from existing data from the blood bank and hematology laboratory. C reactive protein (CRP) and complete blood count (CBC) levels were observed in Covid-19 patients. Both genders, all age groups, COVID-19 patients and patients having Thrombocytopenia and raised levels of CRP were included in this study. At the same time, other bone marrow transplant patients and other infectious diseases such as Hepatitis B, Hepatitis C, Dengue, and Malaria were excluded from this study. Statistical analysis was done by using the SPSS 20.0 version.
RESULTS: Out of 844 patients, the mean age was 50 years, and the male proportion was high at 70% (n=590). Most patients, 95% (n=803) had grade 1 thrombocytopenia. The mean age was found to be higher (>50 years) in Grades 1 and 2 as compared to Grades 3 and 4, where we found (<40 years). A significant (p=0.002) mean age difference among grades was found. No significant (p=0.749) median difference in CRP among Grades were found.
CONCLUSION: The current study shows that COVID-19 significantly increases C-reactive protein levels. While treating and managing the patients of COVID-19, it is essential to detect the biomarkers that can predict the severity and prognosis of this disease.
References
Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX et al. Clinical characteristics of coronavirus disease 2019 in China. New Engl J Med. 2020 Apr 30; 382(18): 1708-20. doi: 10.1056/NEJMoa2002032. Epub 2020 Feb 28.
Thachil J. What do monitoring platelet counts in COVID?19 teach us? J Thrombosis Haemost. 2020 Aug; 18(8): 2071-2. doi: 10.1111/jth.14879. Epub 2020 May 12.
Pavord S, Thachil J, Hunt BJ, Murphy M, Lowe G, Laffan M et al. Practical guidance for the management of adults with immune Thrombocytopenia during the COVID?19 pandemic. Br J Haematol. 2020 Jun; 189(6): 1038-43. doi: 10.1111/bjh.16775.
Stasi R. How to approach Thrombocytopenia. Hematology Am Soc Hematol Educ Program. 2012; 2012: 191-7. doi: 10.1182/asheducation-2012.1.191.
Aster RH. Pooling of platelets in the spleen: role in the pathogenesis of "hypersplenic" Thrombocytopenia. J Clin Invest. 1966 May 1; 45(5): 645-57. doi: 10.1172/JCI105380.
Teo CP, Kueh YK. Incidence of Thrombocytopenia in an acute care hospital. Ann Acad Med Singap. 1989 Jul; 18(4): 379-81.
Hui P, Cook DJ, Lim W, Fraser GA, Arnold DM. The frequency and clinical significance of Thrombocytopenia complicating critical illness: a systematic review. Chest. 2011 Feb; 139(2): 271-8. doi: 10.1378/chest.10-2243. Epub 2010 Nov 11.
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020 Feb 15; 395(10223): 507-13. doi: 10.1016/S0140-6736(20)30211-7. Epub 2020 Jan 30.
Warusevitane A, Karunatilake D, Sim J, Smith C, Roffe C. Early diagnosis of pneumonia in severe stroke: clinical features and the diagnostic role of C-reactive protein. PLoS One. 2016; 11(3): e0150269. doi: 10.1371/journal.pone. 0150269.
Lorenzo-Villalba N, Zulfiqar AA, Auburtin M, Schuhmacher MH, Meyer A, Maouche Y et al. Thrombocytopenia in the course of COVID-19 infection. Eur J Case Rep Intern Med. 2020; 7(6): 001702. Doi: 10.12890/2020_001702.
Monteagudo M, Amengual MJ, Munoz L, Soler JA, Roig I, Tolosa C. Reticulated platelets as a screening test to identify thrombocytopenia aetiology. QJM. 2008 Jul; 101(7): 549-55. doi: 10.1093/qjmed/hcn047. Epub 2008 Apr 8.
Kurata Y, Hayashi S, Kiyoi T, Kosugi S, Kashiwagi H, Honda S et al. Diagnostic value of tests for reticulated platelets, plasma glycocalicin, and thrombopoietin levels for discriminating between hyperdestructive and hypoplastic Thrombocytopenia. Am J Clin Pathol. 2001 May; 115(5): 656-64. doi: 10.1309/RAW2-0LQW-8YTX-941V.
Gauer R, Braun MM. Thrombocytopenia. Am Fam Physician. 2012 Mar 15; 85(6): 612-22.
Paramjit E, Rao R, Sudhamani S, Roplekar P, Shaffi Z, Roy S. Spectrum of Thrombocytopenia: A clinicopathological study with review of the literature. Muller J Med Sci Res. 2016 Jul; 7(2): 121-4.
Lee Y, McKechnie T, Doumouras AG, Handler C, Eskicioglu C, Gmora S et al. Diagnostic value of C-reactive protein levels in postoperative infectious complications after bariatric surgery: a systematic review and meta-analysis. Obes Surg. 2019 Jul; 29(7): 2022-2029. doi: 10.1007/s11695-019-03832-5.
Johns I, Moschonas KE, Medina J, Ossei-Gerning N, Kassianos G, Halcox JP. Risk classification in primary prevention of CVD according to QRISK2 and JBS3' heart age', and prevalence of elevated high-sensitivity C reactive protein in the UK cohort of the EURIKA study. Open Heart. 2018 Nov 17; 5(2): e000849. Doi 10.1136/openhrt-2018—000849.
Tang YW, Schmitz JE, Persing DH, Stratton CW. Laboratory diagnosis of COVID-19: current issues and challenges. J Clin Microbiol. 2020 May 26; 58(6): e00512. doi: 10.1128/JCM.00512-20. Print 2020 May 26.
Bivona G, Agnello L, Ciaccio M. Biomarkers for prognosis and treatment response in COVID-19 patients. Ann Lab Med. 2021 Nov 1; 41(6): 540-8. doi: 10.3343/alm.2021.41.6.540.
Violi F, Pastori D, Cangemi R, Pignatelli P, Loffredo L. Hypercoagulation and antithrombotic treatment in coronavirus 2019: a new challenge. Thromb Haemost. 2020 Jun; 120(06): 949-56. doi: 10.1055/s-0040-1710317.
Abdelhamid Y, Kasten K, Dunne J, Hartley WC, Young CM, Cordes DB et al. Isothiourea-Catalyzed [2+2] Cycloaddition of C (1)-Ammonium Enolates and N-Alkyl Isatins. Org Lett. 2022 Jul 29; 24(29): 5444-9. doi: 10.1021/acs.orglett.2c02170.
Nijsten MW, ten Duis HJ, Zijlstra JG, Porte RJ, Zwaveling JH, Paling JC. Blunted rise in platelet count in critically ill patients is associated with worse outcome. Crit Care Med. 2000 Dec; 28(12): 3843-6. doi: 10.1097/00003246-20001 2000-00017.
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. Lancet. 2020 Feb 15; 395(10223): 497-506. doi: 10.1016/S0140-6736(20)30183-5. Epub 2020 Jan 24.
Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020 Feb 15; 395(10223): 514-23. doi: 10.1016/S0140-6736(20)30154-9. Epub 2020 Jan 24.
Feng G, Zheng KI, Yan QQ, Rios RS, Targher G, Byrne CD et al. COVID-19 and liver dysfunction: current insights and emergent therapeutic strategies. J Clin Transl Hepatol. 2020 Mar 28; 8(1): 18-24. doi: 10.14218/JCTH.2020.00018. Epub 2020 Mar 30.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Journal of Liaquat University of Medical & Health Sciences
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Submission of a manuscript to the journal implies that all authors have read and agreed to the content of the undertaking form or the Terms and Conditions.
When an article is accepted for publication, the author(s) retain the copyright and are required to grant the publisher the right of first publication and other non-exclusive publishing rights to JLUMHS.
Articles published in the Journal of Liaquat University of Medical & health sciences are open access articles under a Creative Commons Attribution-Noncommercial - Share Alike 4.0 License. This license permits use, distribution and reproduction in any medium; provided the original work is properly cited and initial publication in this journal. This is in accordance with the BOAI definition of open access. In addition to that users are allowed to remix, tweak and build upon the work non-commercially as long as appropriate credit is given and the new creations are licensed under the identical terms. Or, in certain cases it can be stated that all articles and content there in are published under creative commons license unless stated otherwise.
