RT Journal Article
SR Electronic
T1 Atypical lymphoid cells circulating in blood in COVID-19 infection: morphology, immunophenotype and prognosis value
JF Journal of Clinical Pathology
JO J Clin Pathol
FD BMJ Publishing Group Ltd and Association of Clinical Pathologists
SP 104
OP 111
DO 10.1136/jclinpath-2020-207087
VO 75
IS 2
A1 Merino, Anna
A1 Vlagea, Alexandru
A1 Molina, Angel
A1 Egri, Natalia
A1 Laguna, Javier
A1 Barrera, Kevin
A1 Boldú, Laura
A1 Acevedo, Andrea
A1 Díaz-Pavón, Mar
A1 Sibina, Francesc
A1 Bascón, Francisca
A1 Sibila, Oriol
A1 Juan, Manel
A1 Rodellar, José
YR 2022
UL http://jcp.bmj.com/content/75/2/104.abstract
AB Aims Atypical lymphocytes circulating in blood have been reported in COVID-19 patients. This study aims to (1) analyse if patients with reactive lymphocytes (COVID-19 RL) show clinical or biological characteristics related to outcome; (2) develop an automatic system to recognise them in an objective way and (3) study their immunophenotype.Methods Clinical and laboratory findings in 36 COVID-19 patients were compared between those showing COVID-19 RL in blood (18) and those without (18). Blood samples were analysed in Advia2120i and stained with May Grünwald-Giemsa. Digital images were acquired in CellaVisionDM96. Convolutional neural networks (CNNs) were used to accurately recognise COVID-19 RL. Immunophenotypic study was performed throughflow cytometry.Results Neutrophils, D-dimer, procalcitonin, glomerular filtration rate and total protein values were higher in patients without COVID-19 RL (p<0.05) and four of these patients died. Haemoglobin and lymphocyte counts were higher (p<0.02) and no patients died in the group showing COVID-19 RL. COVID-19 RL showed a distinct deep blue cytoplasm with nucleus mostly in eccentric position. Through two sequential CNNs, they were automatically distinguished from normal lymphocytes and classical RL with sensitivity, specificity and overall accuracy values of 90.5%, 99.4% and 98.7%, respectively. Immunophenotypic analysis revealed COVID-19 RL are mostly activated effector memory CD4 and CD8 T cells.Conclusion We found that COVID-19 RL are related to a better evolution and prognosis. They can be detected by morphology in the smear review, being the computerised approach proposed useful to enhance a more objective recognition. Their presence suggests an abundant production of virus-specific T cells, thus explaining the better outcome of patients showing these cells circulating in blood.All data relevant to the study are included in the article.