Haematological manifestations in patients with severe acute respiratory syndrome: retrospective analysis

Abstract

Objectives: To evaluate the haematological findings of patients with severe acute respiratory syndrome (SARS).

Design: Analysis of the demographic, clinical, and laboratory characteristics of patients with SARS.

Setting: Prince of Wales Hospital, Hong Kong. Subjects All patients with a diagnosis of SARS between 11 March and 29 March 2003 who had no pre-existing haematological disorders.

Main outcome measures: Clinical end points included the need for intensive care and death. Univariate and multivariate analyses were performed to examine factors associated with adverse outcome.

Results: 64 male and 93 female patients were included in this study. The most common findings included lymphopenia in 153 (98%) of the 157 patients, neutrophilia in 129 (82%), thrombocytopenia in 87 patients (55%), followed by thrombocytosis in 77 (49%), and isolated prolonged activated partial thromboplastin time in 96 patients (63%). The haemoglobin count dropped by more than 20 g/l from baseline in 95 (61%) patients. Four patients (2.5%) developed disseminated intravascular coagulation. Lymphopenia was shown in haemato-lymphoid organs at postmortem examination. Multivariate analysis showed that advanced age and a high concentration of lactate dehydrogenase at presentation were independent predictors of an adverse outcome. Subsets of peripheral blood lymphocytes were analysed in 31 patients. The counts of CD4 positive and CD8 positive T cells fell early in the course of illness. Low counts of CD4 and CD8 cells at presentation were associated with adverse outcomes.

Conclusions: Abnormal haematological variables were common among patients with SARS. Lymphopenia and the depletion of T lymphocyte subsets may be associated with disease activity.

Figures

Fig 5

Histology of spleen. White pulp depletion was noted in all cases. Only a scanty amount of lymphoid cells were surrounding the splenic arterioles (haematoxylin and eosin stain, X200)

Fig 1

Proportion of patients with absolute lymphopenia during the course of SARS. The number in parentheses indicates the number of observations available at each of the different time points

Fig 2

Individual plots of CD4 and CD8 lymphocyte subsets in peripheral blood against day of illness in 31 patients

Fig 2

Individual plots of CD4 and CD8 lymphocyte subsets in peripheral blood against day of illness in 31 patients

Fig 3

Proportion of patients with various platelet counts during the course of SARS. The number in parentheses indicates the number of observations available at each of the different time points

Fig 4

Proportion of patients with abnormal activated partial thromboplastin time during the course of SARS. The number in parentheses indicates the number of observations available at each of the different time points