Cytopenias in Hospitalized Patients of COVID-19 During First and Other Waves
Conditions: Corona Virus Infection
Sponsor: Fatima Memorial Hospital

Title: 
Cytopenias in Hospitalized patients of COVID-19 during first and other waves  
 
Introduction: 
COVID-19 is a global pandemic and since December 2019 we have seen different variants and 
different severity levels of this disease. Laboratory parameters has played quite an important role 
in diagnosis as well predicting the prognosis and disease course. The corona virus SARS CoV-2 
which is responsible for the current global pandemic that has resulted in considerable morbidity 
and mortality1. 
 COVID-19 is highly communicable disease and can lead to diversity of symptoms ranging from 
mild fever, dry cough, myalgias and headache to at times gastrointestinal symptoms including 
abdominal pain, diarrhea and vomiting 2. Pakistan being at the adjacent  border of China and Iran 
was at great threat of infiltration and two confirmed case of Corona virus were reported in city 
Karachi and Islamabad on February 26th 20203.To date Pakistan Has faced more than three waves 
of COVID-19, the first wave span from late May to Mid July 2020, second wave spans from early 
November to mid December 2020 and third wave spans from Mid March 2021 to June 2021.  
COVID-19 and its relationship with laboratory parameters have been well established by many 
studies. The clinicians might consider the hematological and biochemical parameters in the 
patients with COVID-19 in future decision-making. These indicators may sustain clinical 
decisions to recognize high fatality case and poor diagnosis in the initial admission phase4.COVID-
19 is considered mainly to involve respiratory system, but multi systemic involvement is also seen 
in the evolving data from managing the patients of COVID-19. Hemopoietic system is one of them 
and blood count anomalies like neutrophilia and lymphopenia are particularly seen in COVID-19 
patients and also have a prognostic significance5.NLR (neutrophil to lymphocyte ratio), MLR 
(monocyte to lymphocyte Ratio) And PLR be used as a useful predictive marker for the disease 
course as well as severity and outcome of COVID-19 patients.  Systemic immune inflammatory 
index (SII) has a positive prognostic value6. 
 
 
 

Objective: 
It was observed that cytopenias are more prominent in patients during subsequent waves of 
COVID-19. The aim of this study was statistical verification of this observed phenomena.  
Materials and methods: 
Study design: Retrospective Cross-sectional study 
Sample size: 202  
Study Setting: Department of Pathology and Department of Medicine, FMH.  
Eligibility criteria: 
Inclusion Criteria: 
• COVID-19 positive Hospitalized patients 
• Both genders 
• All ages 
Exclusion Criteria: 
• Know patients with Chronic liver disease 
• Known patients with Hematological disorders 
Materials and methods: 
Clinical and laboratory data as well as outcome of total 202 COVID-19 PCR positive patients 
admitted in Fatima memorial Hospital, Lahore, Pakistan will be collected after IRB approval and 
informed consent from patient during first and other waves.  Data of First wave is from May 2020 
to July 2020, second wave from early November to Mid December 2020 and third wave from Mid-
march to June 2021. Comparison of data on basis of SII as well hematological parameters of First 
Wave will be compared to other waves of COVID-19. CBC will be performed on Sysmex XN-10.  
WHO normal values will be taken as reference for CBC. Neutrophil to lymphocyte ratio (NLR) 
will be calculated as N/L And >3 will be considered as raised NLR. Platelet to lymphocyte Ratio 
(PLR) will be calculated as P/L. Raised PLR will be >149 for Males and >172 for females. 
Monocyte to lymphocyte ratio will be also calculated by M/L and >0.23 will be considered as 
raised value. Systemic immune inflammatory index is calculated by P x N/L. SII > 600 will be 
labelled as raised and bad prognostic tool. 

 
Statistical analysis: 
Continuous variables will be analyzed by Man-Whitney analysis and categorical variables will 
be analyzed by independent T test. All the data will be entered and analyzed in SPSS 25. P-value 
equal to or less than 0.05 will be considered significant. 
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