SARS-CoV-2 Infection: Differences in Hematological Parameters Between Adults and Children

Figures & data

Table 1 The Hematological Parameters of Adults with COVID-19 Between Severe Patients and Non-Severe Patients

Reference	Leucocytes,×10^9/L, Median (IQR)		Lymphocytes, ×10^9/L, Median (IQR)		Neutrophils, ×10^9/L, Median (IQR)		Neutrophil to Lymphocyte Ratio, Median (IQR)		D-Dimer, μg/L, Median (IQR)
	Non-Severe	Severe	Non-Severe	Severe	Non-Severe	Severe	Non-Severe	Severe	Non-Severe	Severe
[^Citation11]	NR	NR	1.0 (0.7–1.3)	0.8 (0.6–1.1)	3.2 (2.1–4.4)	4.3 (2.9–7.0)	3.2 (1.8–4.9)	5.5 (3.3–10.0)	NR	NR
[^Citation20]	NR	NR	0.9 (0.6–1.2)	0.8 (0.5–0.9)	2.7 (1.9–3.9)	4.6 (2.6–7.9)	NR	NR	106.0 (101.0–285.0)	414.0 (191.0–1324.0)
[^Citation23]	5.7 (3.1–7.6)	11.3 (5.8–12.1)	1.0 (0.7–1.1)	0.4 (0.2–0.8)	4.4 (2.0–6.1)	10.6 (5.0–11.8)	NR	NR	500.0 (300.0–800.0)	2400.0 (600.0–14,400.0)
[^Citation42]	5.0 (3.8–6.0)	7.0 (4.5–11.3)	1.2 (0.9–1.6)	0.5 (0.3–0.9)	3.1 (2.1–4.2)	6.1 (3.3–10.1)	NR	NR	420.0 (340.0–850.0)	1220.0 (550.0–11,540.0)
[^Citation57]	4.9 (4.0–5.6)	5.2 (4.7–6.8)	1.4 (1.0–1.8)	0.9 (0.7–1.3)	2.8 (2.1–3.5)	3.3 (3.0–5.8)	NR	NR	NR	NR
[^Citation68]	4.4 (3.6–5.7)	7.4 (4.2–8.6)	1.2 (0.9–1.5)	0.6 (0.4–0.9)	NR	NR	2.9 (1.7–3.5)	8.7 (3.7–14.4)	NR	NR

Notes: Presentation for median (IQR); p value<0.05.

Abbreviations: NR, Not Report; IQR, interquartile range.

Table 2 The Ratio of Hematological Value in Adults and Children with COVID-19

	Adults								Children
Reference	[^Citation10]	[^Citation23]	[^Citation29]	[^Citation45]	[^Citation51]	[^Citation69]	[^Citation70]	[^Citation81]	[^Citation15]	[^Citation26]	[^Citation34]	[^Citation35]	[^Citation37]	[^Citation41]	[^Citation63]	[^Citation89]
Region	China	China	Turkey	China	China	China	China	China	China	Morocco	Turkey	Turkey	United States	Saudi Arabia	United Arab Emirates	Oman
Total patients	1099	41	302	582	138	149	135	161	36	68	40	251	288 (MIS-C)	88	288	56
Severe	173	13	25	116	56	NR	40	30	NR	NR	NR	NR	148	5	NR	5
Non-severe	926	28	277	466	82	NR	95	131	NR	NR	NR	NR	140	83	NR	51
Leucopenia(%)	33.7	25.0	12.9	NR	19.6	24.2	20.7	41.0	31.0	8.3	13.3	NR	NR	18.0	NR	21.0
Neutropenia(%)	NR	NR	8.3	NR	NR	22.8	NR	NR	NR	13.9	23.3	14.3	<40.0	7.2	10.4	NR
Lymphopenia(%)	83.2	63.0	19.2	51.6	75.4	35.6	50.4	26.1	31.0	2.8	30.0	25.9	>75.0	21.7	NR	39.0
Anemia(%)	NR	NR	40.4	8.7	NR	NR	NR	8.1	NR	5.9	NR	NR	>40.0	NR	NR	NR
Thrombocytopenia(%)	36.2	5.0	14.2	16.7	NR	13.4	17.0	6.8	NR	5.6	NR	4.40	>50.0	NR	72.0	NR
D-dimer>500μg/L(%)	46.4	NR	66.6	66.7	43.2	14.1	NR	NR	8.3	33.5	NR	NR	NR	38.7	NR	NR

Notes: Leucopenia means leucocytes are less than 4.0×10^9/L; Neutropenia means neutrophils are less than 1.5×10^9/L; Lymphopenia means lymphocytes are less than 1.5×10^9/L; Anemia means hemoglobin are less than 120g/L; Thrombocytopenia means platelets are less than 150×10^9/L; The normal value of D-dimer is less than 500μg/L.

Abbreviations: NR, Not Report; MIS-C, Multisystem Inflammatory Syndrome of COVID-19.

Table 3 The Main Hematological Parameters in Adults and Children with COVID-19

	Adults								Children
First author	[^Citation10]	[^Citation11]	[^Citation12]	[^Citation20]	[^Citation23]	[^Citation29]	[^Citation68]	[^Citation70]	[^Citation15]	[^Citation26]	[^Citation35]	[^Citation41]	[^Citation63]	[^Citation65]	[^Citation71]	[^Citation89]
Region	China	China	Italy	China	China	Umraniye	China	China	China	Morocco	Turkey	Saudi Arabia	United Arab Emirates	Kuwait and Saudi Arabia	United States	Oman
Total patients	1099	452	105	138	41	302	116	135	36	68	251	88	288	25	27	56
Age, years, median (IQR) or mean±SD	47.0 (35.0–58.0)	58.0 (47.0–67.7)	61.8 ±16.4	56.0 (25.0–87.0)	47.0 (35.0–58.0)	57.1 ±17.6	50.0 (41.0–57.0)	47.0 (36.0–55.0)	8.3 ±3.5	<15.0	8.9 ±6.0	5.7 ±4.7	6.5 (2.0–12.3)	2.8 (0.2–8.5)	<21.0	1.8 (0.2–6.9)
WBC,×10^9/L, median (IQR) or mean±SD	4.7 (3.5–6.0)	5.3 (3.9–7.5)	6.5 ±2.6	4.5 (3.3–6.2)	6.2 (4.1–10.5)	6.8 (0.9–34.3)	4.6 (3.7–6.4)	5.4 (4.1–7.8)	6.1 ±2.1	12.3 (3.8–22.9)	10.0 ±5.8	7.9 ±3.7	7.4 (5.4–9.6)	10.0 ±8.8	20.6 ±12.1	9.4 (5.8–12.9)
NEU, ×10^9/L, median (IQR) or mean±SD	NR	3.9 (2.6–5.8)	4.8 ±2.4	3.0 (2.0–4.9)	5.0 (3.3–8.9)	4.5 (0.6–31.6)	3.1 (2.3–4.3)	3.5 (2.6–4.4)	NR	3.3 (1.0–7.0)	6.3 ±3.9	3.8 ±3.1	2.3 (1.6–3.6)	6.2 ±6.2	15.3 ±10.0	3.8 (1.7–7.5)
LYM, ×10^9/L median (IQR) or mean±SD	1.0 (0.7–1.3)	0.9 (0.6–1.2)	1.1 ±0.8	0.8 (0.6–1.1)	0.8 (0.6–1.1)	1.4 (0.1–4.2)	1.0 (0.7–1.4)	1.1 (0.7–1.5)	2.4 ±0.8	4.3 (1.3–12.5)	2.8 ±2.3	3.3 ±2.0	NR	2.68 ±2.5	1.3 ±1.1	2.7 (1.7–5.0)
NLR median (IQR) or mean±SD	NR	4.2 (2.5–7.7)	NR	NR	NR	3.1 (0.6–50.0)	2.9 (1.8–4.8)	NR	NR	NR	4.7 ±6.3	NR	NR	NR	NR	NR
Hb, g/L median (IQR) or mean±SD	134.0 (119.0–148.0)	NR	NR	NR	126.0 (118.0–140.0)	125.0 (60.0–166.0)	132.5 (122.3–145.8)	133.0 (122.0–147.0)	NR	125.6 (77.0–158.0)	125.0 ±18.4	120.6 ±23.8	125.0 (116.0–133.0)	111.0 ±34.5	94.0 ±29.0	109.0 (93.0–124.0)
PLT, ×10^9/L median (IQR) or mean±SD	168.0 (132.0–207.0)	NR	208.1 ±92.1	163.0 (123.0–189.0)	164.5 (131.5–263.0)	218.0 (34.0–553.0)	180.5 (145.5–229.0)	158.0 (131.0–230.0)	NR	NR	283.6 ±77.4	318.5 ±134.7	87.0 (255.0–372.0)	243.0 ±167.0	175.0 ±173.0	328.0 ±153.0
D-dimer, μg/L median (IQR) or mean±SD	>500 ug/L, 46.4%	NR	NR	NR	500.0 (300.0–1300.0)	793.0 (20.0–19,400.0)	NR	400.0 (200.0–600.0)	290.0 ±200.0	3100.0 (270.0–12,000.)	1434.0 ±1337.0	400.0 (300.0–1370.0)	NR	NR	NR	860.0 (530.0–3080.0)

Notes: Normal value: WBC (4.0–10.0)×10^9/L; NEU (1.8–6.3)×10^9/L; LYM (1.1–3.2)×10^9/L; Hb (110.0–160.0)g/L; PLT (100.0–300.0)×10^9/L; D-dimer <500.0μg/L.

Abbreviations: IQR, interquartile range; NR, Not Report; WBC, White blood cell; NEU, Neutrophil; LYM, Lymphocyte; NLR, Neutrophil to lymphocyte ratio; Hb, Hemoglobin; PLT, Platelet.

Qin C, Zhou L, Hu Z, et al. Dysregulation of immune response in patients with coronavirus 2019 (COVID-19) in Wuhan, China. Clin Infect Dis. 2020;71(15):762–768. doi:10.1093/cid/ciaa248

 PubMed Web of Science ®Google Scholar

Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061–1069. doi:10.1001/jama.2020.1585

 PubMed Web of Science ®Google Scholar

Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506. doi:10.1016/S0140-6736(20)30183-5

 PubMed Web of Science ®Google Scholar

Liu Y, Du X, Chen J, et al. Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. J Infect. 2020;81(1):6–12. doi:10.1016/j.jinf.2020.04.002

 Web of Science ®Google Scholar

Qian GQ, Yang NB, Ding F, et al. Epidemiologic and clinical characteristics of 91 hospitalized patients with COVID-19 in Zhejiang, China: a retrospective, multi-centre case series. QJM. 2020;113(7):474–481. doi:10.1093/qjmed/hcaa089

 PubMed Web of Science ®Google Scholar

Sun S, Cai X, Wang H, et al. Abnormalities of peripheral blood system in patients with COVID-19 in Wenzhou, China. Clin Chim Acta. 2020;507:174–180. doi:10.1016/j.cca.2020.04.024

 PubMed Web of Science ®Google Scholar

Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708–1720. doi:10.1056/NEJMoa2002032

 PubMed Web of Science ®Google Scholar

Keski H. Hematological and inflammatory parameters to predict the prognosis in COVID-19. Indian J Hematol Blood Transfus. 2021:1–9. Online ahead of print. doi:10.1007/s12288-021-01407-y

 Web of Science ®Google Scholar

Chen Y, Zhou X, Yan H, et al. CANPT score: a tool to predict severe COVID-19 on admission. Front Med (Lausanne). 2021;8:608107. doi:10.3389/fmed.2021.608107

 PubMed Web of Science ®Google Scholar

Zhang JJ, Dong X, Cao YY, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy. 2020;75(7):1730–1741. doi:10.1111/all.14238

 PubMed Web of Science ®Google Scholar

Yang W, Cao Q, Qin L, et al. Clinical characteristics and imaging manifestations of the 2019 novel coronavirus disease (COVID-19): a Multi-Center Study in Wenzhou city, Zhejiang, China. J Infect. 2020;80(4):388–393. doi:10.1016/j.jinf.2020.02.016

 PubMed Web of Science ®Google Scholar

Wan S, Xiang Y, Fang W, et al. Clinical features and treatment of COVID-19 patients in northeast Chongqing. J Med Virol. 2020;92(7):797–806. doi:10.1002/jmv.25783

 PubMed Web of Science ®Google Scholar

Zheng F, Tang W, Li H, et al. Clinical characteristics of 161 cases of corona virus disease 2019 (COVID-19) in Changsha. Eur Rev Med Pharmacol Sci. 2020;24(6):3404–3410. doi:10.26355/eurrev_202003_20711

 PubMed Web of Science ®Google Scholar

Qiu H, Wu J, Hong L, et al. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an Observational Cohort Study. Lancet Infect Dis. 2020;20(6):689–696. doi:10.1016/S1473-3099(20)30198-5

 PubMed Web of Science ®Google Scholar

Bourkhissi L, Fakiri KE, Nassih H, et al. Laboratory abnormalities in children with novel coronavirus disease 2019. Clin Med Insights Pediatr. 2020;14:1179556520955177. doi:10.1177/1179556520955177

 Google Scholar

Yarali N, Akcabelen YM, Unal Y, Parlakay AN. Hematological parameters and peripheral blood morphologic abnormalities in children with COVID-19. Pediatr Blood Cancer. 2021;68(2):28596. doi:10.1002/pbc.28596

 Web of Science ®Google Scholar

Guner Ozenen G, Sahbudak Bal Z, Umit Z, et al. Demographic, clinical, and laboratory features of COVID-19 in children: the role of mean platelet volume in predicting hospitalization and severity. J Med Virol. 2021;93(5):3227–3237. doi:10.1002/jmv.26902

 PubMed Web of Science ®Google Scholar

Feldstein LR, Rose EB, Horwitz SM, et al. Multisystem inflammatory syndrome in U.S. children and adolescents. N Engl J Med. 2020;383(4):334–346. doi:10.1056/NEJMoa2021680

 PubMed Web of Science ®Google Scholar

Shahin W, Rabie W, Alyossof O, et al. COVID-19 in children ranging from asymptomatic to a multi-system inflammatory disease: a Single-Center Study. Saudi Med J. 2021;42(3):299–305. doi:10.15537/smj.2021.42.3.20200625

 PubMed Web of Science ®Google Scholar

Elghoudi A, Aldhanhani H, Ghatasheh G, et al. COVID-19 in children and young adolescents in Al Ain, United Arab Emirates- a Retrospective Cross-Sectional Study. Front Pediatr. 2020;8:603741. doi:10.3389/fped.2020.603741

 PubMed Web of Science ®Google Scholar

Al Yazidi LS, Al Hinai Z, Al Waili B, et al. Epidemiology, characteristics and outcome of children hospitalized with COVID-19 in Oman: a Multicenter Cohort Study. Int J Infect Dis. 2021;104:655–660. doi:10.1016/j.ijid.2021.01.036

 PubMed Web of Science ®Google Scholar

Ferrari D, Motta A, Strollo M, et al. Routine blood tests as a potential diagnostic tool for COVID-19. Clin Chem Lab Med. 2020;58(7):1095–1099. doi:10.1515/cclm-2020-0398

 PubMed Web of Science ®Google Scholar

Alfraij A, Bin Alamir AA, Al-Otaibi AM, et al. Characteristics and outcomes of coronavirus disease 2019 (COVID-19) in critically ill pediatric patients admitted to the intensive care unit: a Multicenter Retrospective Cohort Study. J Infect Public Health. 2021;14(2):193–200. doi:10.1016/j.jiph.2020.12.010

 PubMed Web of Science ®Google Scholar

Mitchell WB, Davila J, Keenan J, et al. Children and young adults hospitalized for severe COVID-19 exhibit thrombotic coagulopathy. Pediatr Blood Cancer. 2021;68(7):28975. doi:10.1002/pbc.28975

 PubMed Web of Science ®Google Scholar