COVID-19: Routine hematology parameters play a significant role in diagnosis

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It is interesting to know how a routine blood test can give the clinician a plethora of information! Pathologists the world over are relying on various hematology parameters for severity assessment of COVID-19.



Renowned scientific and clinical publications have now concluded that various biochemistry and hematology parameters play an essential role in the early detection, prognosis and management of COVID-19.

Significant reduction in absolute Lymphocyte count and Hemoglobin, is associated with the increase in total WBC count, absolute Neutrophil count, ESR, Prothrombin Time, D-Dimer, C-Reactive Protein and Pro-calcitonin. Additionally, various routine biochemical parameters also get deranged and signify the severity and poor prognosis. These lab findings, especially elevated Ferritin levels, suggest an imminent ‘Cytokine Storm’ which might lead to complications like Acute Respiratory Distress Syndrome (ARDS), Pneumonia and Multi-organ Failure (MOD). Elevated troponins & CK-MB signifies myocardial injury and subsequent fulminant myocarditis, which is associated with adverse outcome.

Important laboratory findings in COVID-19 patients:

Neutrophil-to-Lymphocyte Ratio predicts severe illness in patients at early stage: Neutrophil-to-lymphocyte ratio (NLR) is a simple parameter to assess the inflammatory status of a patient by early identification of risk factors. In a study it was identified that normal NLR values in an adult, non-geriatric population in good health are between 0.78 - 3.53. In another study, it was concluded that patients ≥50 years having NRL ≥3.13 are at risk of severe illness, and they should get rapid access to ICU, if necessary. 

Dysregulation of Immune response: Novel coronavirus mainly acts on lymphocytes, especially T lymphocytes. Surveillance of NLR and lymphocyte subsets can be helpful in the early screening of critical illness, diagnosis and treatment of COVID-19. Dysregulation of immune response, especially T lymphocytes, is most likely to be involved in the patho-physiology of COVID-19 infection.

Hematologic Microscopic Parameters: Microscopic peripheral blood film review shows a higher number of patients who are lymphopenic and have the presence of a few reactive lymphocytes, of which a subset appears to be lymphoplasmocytoid. 

Transasia’s latest range of fully automated three and five part differential hematology analyzers, help in providing an accurate and precise evaluation and enumeration of these parameters which play a critical role in management of COVID-19 patients. 


Dr. Avi Nahar
MD Path
Business Unit Head- Hematology

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