key: cord-0722716-z4txz5hj
authors: Sookaromdee, Pathum; Wiwanitkit, Viroj
title: Hematological Findings and Clinical Severity in Pediatric Patients with COVID-19
date: 2021-12-07
journal: Turk J Haematol
DOI: 10.4274/tjh.galenos.2021.2021.0488
sha: f42dd9c1d01ebfa09762c2a59e8a641be32c87c9
doc_id: 722716
cord_uid: z4txz5hj

nan

Turk J Hematol 2021;38:329-346

We thank the author for their interest in our manuscript, and we acknowledge their concerns regarding use of red cell distribution width (RDW) in clinical diagnosis of severity of COVID-19 infected children in places with very high incidence of thalassemia like Indochina. While we agree that pediatric children usually have a high RDW as a background hematological disease, in our study none of the patients had thalassemia as underlying disease. And published studies support usage hematological parameters including RDW in COVID-19 infected cases.

In a published study , a progressive increase of RDW was observed with advancing COVID-19 severity. Also in multivariate analysis, elevated RDW was associated with 9-fold increased odds of severe COVID-19 [1] .

In an other published study, RDW was found to be a prognostic predictor for patients with severe COVID-19, and authors concluded that the increase in reticulocyte may contribute to elevated RDW [2] .In a study conducted in 1641 patients, authors concluded that elevated RDW at the time of hospital admission and an increase in RDW during hospitalization were associated with increased mortality risk for patients with COVID-19 [3] .

In our findings, the NLR ratio was higher in severe/critical cases compared to cases of asymptomatic, mild, and moderate severity. In a study conducted in 245 COVID-19 patients multivariate analysis demonstrated that there was 8% higher risk of in-hospital mortality for each unit increase in NLR (odds ratio [OR] =1.08; 95% confidence interval [95% CI], 1.01 to 1.14; P=0.0147) [4] .

Finally we conclude that hematological parameters of COVID-19 infected pediatric cases may alert physicians about clinical severity. But hematological markers especially RDW should be used correctly as patient-based approach in COVID-19 infected pediatric patients .

Can hematological findings of COVID-19 in pediatric patients guide physicians regarding clinical severity?

Limitations of red blood cell distribution width (RDW) in evaluation of microcytosis

Distribution and reference interval establishment of neutral-to-lymphocyte ratio (NLR), lymphocyteto-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) in Chinese healthy adults

Red Blood Cell Distribution Width (RDW) Predicts COVID-19 Severity: A Prospective, Observational Study from the Cincinnati SARS-CoV-2

Red cell distribution width (RDW): a prognostic indicator of severe COVID-19

Association of Red Blood Cell Distribution Width With Mortality Risk in Hospitalized Adults With SARS-CoV-2 Infection

Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19