In addition to the changes in the counts, morphological changes were also noted in some of the white blood cells. No morphological abnormalities were documented in her CBC at the initial Wellness Visit. However, both the Day 1 Admission smear and the ICU Day 20 smear showed some changes:
1. Neutrophils
- Toxic granulation, Dohle Bodies; and vacuoles are commonly seen; a higher percentage on day 2. The image below shows a neutrophil with many vacuoles.
(2) - Some Pelger-Huet appearing neutrophils on Day 20
- Hypersegmented neutrophils (not associated with B12 or folate deficiencies) have also been seen in COVID smears. Still, they are not necessarily a marker for severity, at least at the time of this writing.
2. Lymphocytes
- Although total lymphocyte counts decreased, the percentage of large granular lymphocytes increased on Day 1 but decreased on day 20.
3. Other hematological changes
- Besides changes in the white blood cells, various changes in the red blood cells also were noted, including an increase in RDW with increasing severity of the disease. Occasional poikilocytes were also seen.
