RESEARCH ARTICLE / ARAŞTIRMA MAKALESİ
DOI: 10.4274/atfm.galenos.2021.09825
Ankara Üniversitesi Tıp Fakültesi Mecmuası 2022;75(2):204-210
MEDICAL SCIENCES / DAHİLİ TIP BİLİMLERİ
COVID-19 Disease in Patients with Hematological Disease-Single
Center Data
Hematolojik Hastalarda COVID-19 Hastalığı-Tek Merkez Verisi
Ferda Can1,
İmdat Dilek2,
Sema Akıncı1,
Tekin Güney1
1Ankara City Hospital, Clinic of Hematology, Ankara, Turkey
2Ankara Yıldırım Beyazıt University Faculty of Medicine, Ankara City Hospital, Clinic of Hematology, Ankara, Turkey
Abstract
Objectives: Coronavirus disease-2019 (COVID-19) is a pandemic that has been the main issue of the healthcare since December 2019. There are
difficulties in treatment and follow-up for hematology patients. In this study, we aimed to share data about the disease and mortality of patients
diagnosed with COVID-19.
Materials and Methods: The patients diagnosed with COVID-19 between March 2020 and February 2021 were included. Patients were retrospectively
analyzed.
Results: Forty-nine patients were evaluated. Twenty-one were female, 28 were male, the median age was 64 (19-84) years. Nineteen patients
had no comorbidities. Thirty patients had 1-4 comorbid diagnoses. Forty-one (83%) patients had malignant hematological diagnosis, 33 (67%)
of them were receiving active chemotherapy. Sixteen (33%) patients were in the cytopenic period. Six patients were asymptomatic at the time
of diagnosis. Nineteen (38.8%) of the patients had mild illness, 6 (12.2%) had moderate COVID-19, 24 (49%) had severe disease. Fourteen (29%)
patients were followed up at home, while 35 (71%) patients were hospitalized. Twenty-one (60%) of the inpatients were followed up in the intensive
care unit. Totally 17 patients (34.6%) died from COVID-19 infection. Being diagnosed with COVID-19 during hospitalization for the hematological
causes, hematological disease status, cytopenia on the day of COVID-19 diagnosis, hospitalization for COVID-19 treatment, lung involvement,
accompanying extrapulmonary organ involvement, decreased hemoglobin level and thrombocyte count, systemic inflammatory response syndrome
development, intensive care admission, intubation and secondary infection during hospitalization were the factors associated with higher mortality.
Conclusion: In this study, we observed that COVID-19 had a higher morbidity and mortality in hematological patients. More attention should be
paid to hematological patient groups in the era of COVID-19 to protect them from the disease.
Key Words: Hematological Diseases, COVID-19, SARS-CoV-2
Öz
Amaç: Koronavirüs hastalığı-2019 (COVID-19), Aralık 2019’dan bu yana sağlık hizmetlerinin ana uğraşı haline gelmiş bir hastalıktır. Hematoloji
hastalarının COVID-19 tedavi ve takiplerinde zorluklar yaşanmaktadır. Bu çalışmada COVID-19 tanısı alan hematolojik hastaların hastalık seyri ve
ölüm oranlarına ilişkin verileri paylaşmayı amaçladık.
Gereç ve Yöntem: Mart 2020 ile Şubat 2021 arasında COVID-19 tanısı konulan hastalar çalışmaya dahil edildi. Hastalar retrospektif olarak incelendi.
Bulgular: Kırk dokuz hasta değerlendirildi. Yirmi biri kadın, 28’i erkek idi, ortanca yaş 64 (19-84) idi. On dokuz hastada komorbidite yoktu. Otuz
hastada 1-4 ek tanı vardı. Kırk bir (%83) hastada malign hematolojik tanı saptandı, 33’ü (%67) aktif kemoterapi alıyordu. On altı (%33) hasta sitopenik
dönemdeydi. Altı hasta tanı anında asemptomatikti. Hastaların 19’u (%38,8) hafif, 6’sı (%12,2) orta derecede COVID-19, 24’ü (%49) ağır hastalığa
sahipti. On dört (%29) hasta evde takip edilirken, 35 (%71) hasta hastaneye yatırıldı. Yatan hastaların 21’i (%60) yoğun bakımda takip edildi. Toplam 17
hasta (%34,6) COVID-19 enfeksiyonundan öldü. Hematolojik nedenlerle hastanede yatışı sırasında COVID-19 tanısı almış olmak, hematolojik hastalık
durumu, COVID-19 tedavisi için yatış, akciğer tutulumu, eşlik eden ekstrapulmoner organ tutulumu, anemi, trombositopeni, sistemik enflamatuvar
yanıt sendromu gelişimi, yoğun bakıma yatış, entübasyon ve sekonder enfeksiyon gelişimi daha yüksek mortalite ile ilişkili bulundu.
Address for Correspondence/Yazışma Adresi: Ferda Can
Ankara City Hospital, Clinic of Hematology, Ankara, Turkey
Phone: +90 535 893 43 99 E-mail: dr.ferda.can@hotmail.com ORCID ID: orcid.org/0000-0002-9899-1441
Received/Geliş Tarihi: 04.09.2021 Accepted/Kabul Tarihi: 16.12.2021
©️Copyright 2022 Ankara University Faculty of Medicine
Journal of Ankara University Faculty of Medicine is published by Galenos Publishing House.
All content are under CC BY-NC-ND license.
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Ankara Üniversitesi Tıp Fakültesi Mecmuası 2022;75(2):204-210
Sonuç: Bu çalışmada, hematolojik hastalarda COVID-19’un daha yüksek morbidite ve mortaliteye sahip olduğunu gözlemledik. Bu nedenle
hematolojik hasta gruplarını COVID-19 döneminde hastalıktan korumak için daha fazla özen gösterilmelidir.
Anahtar Kelimeler: Hematolojik Hastalıklar, COVID-19, SARS-CoV-2
Introduction
Coronaviruses are a group of RNA viruses that can infect
animals and humans, causing respiratory infections in humans.
Coronavirus disease-2019 (COVID-19) infection is the name
given to the infection of the coronavirus subtype, most recently
named severe acute respiratory syndrome coronavirus-2 (SARSCoV-2) (1). In December 2019, COVID-19 infection was first
described as a highly contagious lung infection in China (2). The
infection, which affected the whole world in a short time and
spread rapidly with the inhalation of viral particles, was defined
as a pandemic by the World Health Organization (WHO) in
March 2020, and the first cases began to appear in our country
at that time.
COVID-19 infection status of hematology patients
who have been immunosuppressive due to their diseases
and/or treatments often seems to be challenging from
the beginning of the pandemic (3). Advanced age, male
gender, comorbidities and pregnancy have been defined
as risk factors for COVID-19 progression. Among comorbid
conditions, hematological malignancies are defined as risk
factors because of their immunosuppressive state (4). A
multicenter study, which COVID-19 was evaluated in cancer
patients, including hematological malignancies, showed
that severe COVID-19 development was higher in cancer
patients than in patients without cancer (64% vs 32%) (5).
The same study identified advanced age, high interleukin 6,
procalcitonin, D-dimer levels, low lymphocyte count, advanced
tumor stage as risk factors indicating the severity of COVID-19
disease (5). In different series, COVID-19 mortality was found
to be higher in patients with malignancies compared to noncancer patients, and the mortality rate was reported between
23.5-34% (6-9). In this study, we aimed to share descriptive
data and to determine the mortality status of hematology
patients diagnosed with COVID-19 during their follow-up in
our outpatient and inpatient clinic.
Materials and Methods
Patient Characteristics and Selection
Patients following for a hematological disease and
diagnosed with COVID-19 between March 2020 and February
2021 were included in the study. The data of patients who were
diagnosed during outpatient or clinical follow-up and treated
as outpatients or inpatients were recorded.
Patients who were not diagnosed by us and who were
not followed up by any of the investigators in the study were
excluded.
Patients’ Data
Demographic and laboratory data were obtained from the
electronic hospital database and medical files of the patients.
Patients’ age, sex, comorbidities, detailed information about
underlying hematological diseases, COVID-19 diagnosis date,
symptoms of the disease and symptom onset date, diagnostic
procedure of COVID-19, disease severity, COVID-19 treatment
modalities, hematological parameters at the diagnosis,
development of systemic inflammatory response syndrome
(SIRS), maximum level of ferritin and D-dimer, extrapulmonary
organ involvement, antiaggregant-anticoagulant therapy
status, intensive care unit (ICU) admission and intubation
history, secondary infection coexistence, the latest state of
COVID-19 infection, COVID-19 related mortality-morbidity
status were recorded.
We evaluated the disease severity according to WHO
COVID-19 disease severity definitions. Patients with any of the
following finding classified as severe COVID-19;
⦁ Severe pneumonia that means clinical signs of pneumonia
and having a saturation of peripheral oxygen (SpO2) <90% on
room air or ≥40 breaths in minute.
⦁ Acute respiratory distress syndrome that means patients
on mechanical ventilation with partial pressure arterial oxygen
/fraction of inspired oxygen ≤300 mmHg with positive endexpiratory pressure or continuous positive airway pressure ≥5
cmH2O.
⦁ Sepsis.
⦁ Septic shock.
Patients having clinical signs of pneumonia such as fever,
cough, dyspnea, tachypnea without a sign of severe pneumonia
and SpO2 ≥ 90% on room air classified as moderate disease.
Symptomatic patients without evidence of viral pneumonia or
hypoxia classified as mild disease.
Leukopenia, neutropenia, lymphopenia, thrombocytopenia
at diagnosis of COVID-19 was defined as values below 4x109/L,
1.5x109/L, 1x109/L and 150x109/L respectively.
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Can et al. COVID-19 in Hematological Disease
Statistical Analysis
Continuous variables were given as median (minimummaximum). Categorical variables such as gender and comorbidity
are represented as percentages (%). Continuous characteristics
were compared between groups by Independent samples t-test,
Mann-Whitney U test or Kruskal-Wallis test with respect to
the distribution of characteristics and the number of the
groups. When necessary, Mann-Whitney U test with Bonferroni
correction was applied as post-hoc test after Kruskal-Wallis
test. Chi-square tests were performed to compared categorical
characteristics between groups. Logistic regression analysis was
used to determine independent risk factors for ICU mortality. A
p-value <0.05 was considered as statistically significant.
Ankara Üniversitesi Tıp Fakültesi Mecmuası 2022;75(2):204-210
(47%) patients had a history of contact with a COVID-19 positive
person. At the time of the diagnosis of COVID-19, 6 (12.2%)
patients were asymptomatic. These patients were diagnosed
with polymerase chain reaction (PCR) test before hospitalization
for their hematological disease or due to test because of a
contact history with a COVID-19 positive person. The most
common symptom of the patients was fever or fever with
All statistical analyses were performed with IBM SPSS
Statistics 21.0 (IBM Corp. Released 2012. IBM SPSS Statistics for
Windows, Version 21.0. Armonk, NY: IBM Corp.).
Ethical Standards
Ethics committee approval was received from Ministry of
Health and Ankara City Hospital Local Ethics Committee with
the number E1-21-1715.
Results
Forty-nine patients included in our study. Median age of
the patients was 64 (19-84), 21 were female, 28 were male.
Fifteen of the patients were being followed up with the
diagnosis of acute leukemia, 12 with non-Hodgkin’s lymphoma
and 10 with multiple myeloma. Other diagnoses were chronic
myeloproliferative disease, myelodysplastic syndrome, chronic
lymphocytic leukemia, immune thrombocytopenia, aplastic
anemia (Figure 1).
Twenty of the patients were diagnosed with hematological
disease in the last one year, during COVID-19 period in our
country. Characteristics of the patients are given in Table
1. Forty-one (83%) patients had malignant hematological
diagnosis, 33 (67%) of them were receiving active
chemotherapy. Sixteen (33%) patients were cytopenic at the
time of COVID-19 diagnosis and 11 were receiving steroids as
a part of their chemotherapy. Thirty (61.2%) of the patients
had at least one comorbid disease. Most common comorbid
disease in COVID-19 patients with hematological diseases was
hypertension. There was no active smoker patient but 28 of
them were ex-smokers.
Three patients were diagnosed with COVID-19 until August
2020, while the number of patients diagnosed with COVID-19
after this date was 46 (94%). Twenty-one (43%) patients were
diagnosed with COVID-19 during hospitalization due to their
hematological disease. The median day from onset of COVID-19
associated symptoms to diagnosis was 2 (0-14). Twenty-three
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Figure 1: Hematological diseases of the patients
Table 1: Characteristics of the patients
Characteristics
n=49
Median age (years) (Min.-Max.)
64 (19-84)
Gender
Male (%)
28 (57%)
Female (%)
21 (43%)
Hematological diagnosis
Acute leukemia
15
Multiple myeloma
10
Non-Hodgkin’s lymphoma
9
Other hematological malign diseases
7
Benign hematological diseases
8
Active chemotherapy (%)
Co-morbidities
33 (67%)
None (%)
19 (38%)
1-4 Co-morbid diseases (%)
30 (62%)
Hypertension
21
Smoking status
Non-smoker (%)
21 (43%)
Ex-smoker (%)
28 (57%)
Min.: Minimum, Max.: Maximum
Can et al. COVID-19 in Hematological Disease
Ankara Üniversitesi Tıp Fakültesi Mecmuası 2022;75(2):204-210
other symptoms, respiratory system complaints such as cough,
dyspnea and structural symptoms such as weakness, fatigue,
muscle and bone pain were the other symptoms following fever.
The distribution of symptoms is shown in Table 2. Forty-eight
patients were diagnosed with PCR test positivity, only 1 patient
was diagnosed with thorax computed tomography (CT). CT was
performed simultaneously in 21 (43%) of the patients diagnosed
with PCR.
The hematological parameters of the patients at the time of
diagnosis of COVID-19 are presented in Table 3. Fourteen (28.5%)
of the patients were followed up with outpatient treatment, 2
of them required hospitalization. Thirty-five (71.5%) patients
were treated as inpatients from the time of diagnosis. Twentyone (60%) of the inpatients were followed up in the ICU, and
14 (40%) in the clinic. The number of patients who required
intubation was 13. For COVID-19, 3 patients were followed up
without treatment, 2 patients received only hydroxychloroquine
(HCQ) treatment and 44 (89.7%) patients received favipravir
and/or HCQ, colchicine, steroids. Convalescent plasma therapy
was given to 3 patients. Disease progression in hospitalized
patients was on the median day 4 (1-17). Anti-cytokine
treatment was required for 19 patients. Twelve of these patients
received steroid and intravenous immunoglobulin (IVIG), 7 of
them received steroid therapy alone. All 7 patients who received
steroid therapy alone died. Nine of 12 patients who received
IVIG and steroids died. Secondary infection development was
observed in 22 patients.
The analysis of the data of the patients who were followed
up for D-dimer and ferritin showed a median maximum D-dimer
level 6,235 mg/L (0.51-60.340) and median maximum ferritin
level 1612 µg/L (58-180.498).
Table 2: COVID-19 symptoms of the patients
Symptoms
Number of patients (%)
Asymptomatic
6 (12.2%)
Fever
21 (42.9%)
Respiratory system symptoms
12 (24.5%)
Constitutional symptoms
10 (20.4%)
Total
49 (100%)
COVID-19: Coronavirus disease-2019
Table 3: Hematological parameters on the day of COVID-19
diagnosis
Parameter
Median (Min.-Max.)
Hemoglobin (g/dL)
9.4 (5-15.3)
Leukocyte count (x109/L)
3.75 (0.28-50)
Neutrophil count (x10 /L)
2.32 (0.05-17)
Lymphocyte count (x109/L)
0.66 (0.05-39.6)
Platelet count (x109/L)
116 (8-693)
9
COVID-19: Coronavirus disease-2019, Min.: Minimum, Max.: Maximum
During COVID-19 related hospitalization, Guillain Barre
syndrome developed in one patient. Acute renal failure
development was observed on the basis of chronic renal failure
in three patients, acute renal failure in two patients. Pregnancy
loss in one patient was observed.
Anticoagulant therapy was used in a total of 35 (71.4%)
patients, 24 (49%) of them treated with prophylactic and
11 (22.4%) of them with therapeutic dose. Twelve (24.5%)
patients were given antiaggregant therapy. No thromboembolic
complications were observed.
The median length of hospitalization of the patients was 12
days (1-39), and the median length of ICU duration was 6 days
(1-20). Twenty of the 49 (40.8%) patients died at the end of the
follow-up period. While 16 of these 20 patients died from COVID-19
during hospitalization, 4 of them died after discharge or during
home monitoring. One patient died at home while he was positive
for COVID-19. Three patients recovered from COVID-19 infection
and were discharged, one died due to acute myeloid leukemia
relapse, one due to sepsis during acute lymphoblastic leukemia
treatment, and one patient due to acute myocardial infarction.
Totally 17 patients (34.6%) died from COVID-19 infection.
Three patients needed long-term oxygen treatment at home
after COVID-19 treatment. Treatment follow-up, complications
and mortality distribution of the patients are shown in
Table 4.
Factors affecting COVID-19-related mortality in logistic
regression analysis were detection of the disease during
Table 4: COVID-19 following, complications, mortality of the
patients
Parameters
Number of
patients (%)
Total patients
Outpatients
Inpatients
Inpatients
Clinical follow-up
ICU follow-up
Intubation
49
14 (28.5%)
35 (71.5%)
35
14 (40%)
21 (60%)
13
COVID-19 treatment
No treatment
HQ
Favipravir
Favipravir + HQ
Favipravir + steroid
Favipravir + HQ + steroid
Favipravir + HQ + colchicine + steroid
3
2
13
5
21
2
3
Patients developing SIRS
Steroid therapy
IVIG + Steroid therapy
Total mortality at the end of the follow-up
COVID-19 related mortality
Mortality in ICU patients
19
7
12
20/49 (40.8%)
17/49 (34.6%)
18/21 (85.7%)
ICU: Intensive care unit, HQ: Hydroxychloroquine, SIRS: Systemic inflammatory
response syndrome, IVIG: Intravenous immunoglobulin
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hospitalization of the hematological causes, hematological
disease not in complete response, presence of cytopenia on
the day of COVID-19 diagnosis, requirement hospitalization
for COVID-19 treatment, presence of lung involvement,
accompanying extrapulmonary organ involvement, hemoglobin
level of 10 g/dL or below on the day of COVID-19 diagnosis,
thrombocyte count below 150x109/L, SIRS development,
ICU admission, intubation and secondary infection during
hospitalization (Table 5).
day, D-dimer and ferritin levels, SIRS treatment modalities, use
of antiaggregant-anticoagulant therapy had no significant
effect on mortality (Table 6).
Discussion
In this study, we presented COVID-19 infection data of
our hematological patients. The mortality rate associated with
COVID-19 was 34.5% in our patient group, most of whom
had hematological malignancies and were immunosuppressive
due to the treatments or their hematological disease. In the
literature, COVID-19-related mortality rates in patients with
hematological malignancies have been reported between 28%
and 40% (10-14). This rate has been reported up to 60% in case
series when treatment is not sufficient at the beginning of the
pandemic (15). In a retrospective analysis of Turkish Ministry
of Health comparing patients with hematologic malignancies
and patients without cancer, the mortality rate was 6.8% for
the general population and 13.8% for hematological patients
(16). The low mortality rates in this study were associated with
the high number of chronic myeloproliferative patients who
have less immunosuppressive status and the presence of both
inpatients and outpatients (16).
Age, gender, comorbidity status, type of hematological disease
diagnosis, smoking status, duration of hematological disease
diagnosis, active immunosuppressive treatment status, receiving
steroids and rituximab as part of chemotherapy, modifying/
reducing chemotherapy dosage due to COVID-19 pandemic,
leukocyte-neutrophil-lymphocyte count on COVID-19 diagnosis
Table 5: Factors not associated with COVID-19 mortality
p-value
Age
0.97
Gender
0.35
Hematological diagnosis (malign vs benign)
0.10
Comorbidities
0.08
Smoking (Ex-smoker vs non-smoker)*
0.39
Hematological disease duration (in the last year vs earlier)
0.80
Active chemotherapy treatment
Steroid treatment as a part of chemotherapy
Rituximab treatment in last year
0.88
0.32
0.09
Hematological treatment modification
Leukocyte count (≥4x109/L vs <4x109/L)
Lymphocyte count (≥1x109/L vs <1x109/L)
Neutrophil count (≥1.5x109/L vs <1.5x109/L)
Maximum D-dimer level
Maximum ferritin level
0.36
0.33
0.50
0.56
0.95
0.95
According to the current data of WHO on May 28, 2021,
the death rate associated with COVID-19 in the world is 2%
and in Turkey is 0.8% (17). In our study in which we analyzed
both outpatients and inpatients together with a high rate of
immunosuppressive patients, mortality rates were found to be
compatible with the literature and nearly 20-fold higher from
the general population. High mortality rates suggest that more
attention should be paid to COVID-19 infection in hematological
patients than the general population.
Similar to the general population, it has been shown that
advanced age especially >60 years and comorbidities have
*There are no active smokers
COVID-19: Coronavirus disease-2019
Table 6: Factors effecting COVID-19 associated mortality
p-value
OR, 95% CI
COVID-19 diagnosis while hospitalization
0.04
3.33 (1.01-10.97)
Hematological disease response (CR vs others)
0.04
3.69 (1.05-12.87)
Cytopenia on the day of COVID-19 diagnosis
0.03
3.83 (1.09-13.45)
COVID-19 treatment modality (Inpatient vs outpatient)
0.008
17 (2.08-150.53)
COVID-19 pulmonary involvement
0.001
2.9 (1.75-4.78)
Extrapulmonary involvement
0.002
1.4 (1.0-1.90)
Hemoglobin level on the day of COVID-19 diagnosis (<10 g/dL vs ≥10 g/dL)
0.001
16.87 (3.10-91.84)
Platelet level on the day of COVID-19 diagnosis (<150x10 /L vs ≥150x10 /L)
0.008
7.36 (1.67-32.31)
SIRS development
0.001
34.66 (6.85-175.40)
ICU admission
0.001
78 (11.81-514.98)
Intubation
0.001
42 (4.71-373.81)
Secondary infection
0.001
27.2 (5.71-129.49)
9
9
OR: Odds ratio, CI: Confidence inverval, CR: Complete response, SIRS: Systemic inflammatory response syndrome, ICU: Intensive care unit
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been associated with higher mortality in COVID-19 infection in
hematological patients (10,12-14,18). No relationship between
age, comorbidities and death was found in our study. This may
be attributed to the median age of patients in other studies is
higher than our population.
Expectedly and in accordance with the literature,
unresponsiveness of hematological disease, need for
hospitalization for COVID-19 infection, development of SIRS,
ICU admission and the need for intubation were found to be
associated with higher mortality (10,12-15,18). Although
there are different reports in the literature about the level of
cytopenias and effect on mortality for hematological patients,
in our study, when the leukocyte-lymphocyte-platelet counthemoglobin level was evaluated individually on the day of
COVID-19 diagnosis, the platelet count below 150x109/L and the
hemoglobin level below 10 g/dL were found to be associated with
mortality. In this respect, we think that our study contributed to
this issue, since there is no cut-off in the literature.
Secondary infections in hematologic patients, which are also
not mentioned in the literature, are common in the course of
treatment of all hematological diseases and are important in
the course of COVID-19 and were associated with an increase in
mortality in our study.
Confusion has been arising about the treatment of
hematological patients in the era of COVID-19. Some studies
showed COVID-19 related deaths were higher in patients
receiving active chemotherapy or immunotherapy, it was
recommended to rearrange immunosuppressive therapies, delay
and reduce these treatments as much as possible (10,19). On the
other hand, after it has shown in some studies that active cancer
treatment has no effect on mortality, guidelines recommend
determining the urgency and intensity of hematological
treatment needs on the basis of patient and disease (7,12).
In our study, we observed that active chemotherapy, steroid,
rituximab had no effect on mortality. It can be concluded
that immunosuppression attributed to hematological
disease is more important than immunosuppression due to
chemoimmunotherapy. Hematological patients, with requiring
urgent treatment such as aggressive malignancies should be
treated without delaying, but with strict attention to COVID-19
infection precautions and screening the patients with PCR
regularly as well as before treatments (20-23).
Recently thanks to the increasing number of
clinicopathological studies, parallel with three clinicobiological
phases of the disease; asymptomatic/pre-symptomatic, respiratory
phase and multisystemic syndromic phase are defined (24).
Although we could not clearly identify these phases in our
patients, according to our patients’ symptoms distribution,
asymptomatic cases were only 12.2% of our patient group.
In our study; the significant scarcity of asymptomatic cases
compared to 50-80% reported in the literature confirmed that
immunosuppression caused by the hematological disease or
treatments causes more symptoms associated with COVID-19
than in a healthy person, as expected (24).
The incubation period for COVID-19 was defined as
approximately 5-6 days, and the predicted time for disease
progression was defined as 6-12 days (25,26). In our study,
the median diagnosis day was 2 days and the median disease
progression was on the 4th day. This data showed that the
diagnosis of COVID-19 is faster in hematological patients
compared to the general population. These findings also showed
that the disease progression was faster than expected, and
awareness caused acting quickly for the diagnosis of COVID-19
in hematological patients. It is important to show the sensitivity
for close monitoring of progression and early treatment
interventions to the patients as well as early diagnosis of the
disease.
According to studies with a high number of patients in
the general population, hospitalization rate due to COVID-19
has been report as 9.5%; ICU admission rates in hospitalized
patient have been reported as 7.1%, 22% and 39%; intubation
rates in ICU patients have been reported as 60.2% and 86%
(27-29). Hospitalization rate in hematological-oncological
patients was 78%, 98%; the rate of patients needing ICU
follow-up was 27.5%; The rate of patients requiring intubation
during ICU follow-up was 65.5% (9,30). In our study, the rate
of hospitalization was 71.5%, this rate was slightly lower
than the hematological-oncological patient population, on
the other hand was very high than the general population.
This situation can be explained by the frequent presence of
malignant patients in the literature data of hematological
oncological patients and the inclusion of benign patients in our
study. Rate of patients going to ICU admission in hospitalized
patients is 60% and it differs from the literature. We attribute
the high rate of ICU admission to the awareness of the rapid
progression of hematological patients and admitting patients
to ICU as soon as possible in our center. The requirement for
intubation in ICU was 13/21 (61.9%), which is similar to both
the general population and hematological oncological patients.
Hematological oncological patients do not seem to exhibit a
difference from the general population in terms of intubation
after ICU period.
Study Limitations
There are some limitations in our study. Our study, which
includes retrospective single center data, has a limited number
of patients. Nevertheless, it is one of the rare studies in Turkey
analyzing both benign and malignant hematology patients. It
is thought that debates about the COVID-19 in hematological
patients can be resolved with multi-center studies with high
number of patients.
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Conclusion
COVID-19, a multisystemic pandemic disease, appears
to be a serious cause of mortality in hematological patients.
Hematological diseases have an important effect on COVID-19
related mortality, rapid care of the condition should be done in
this patient group as well as prevention of the infection.
Ethics
Ethics Committee Approval: Ethics committee approval
was received from Ministry of Health and Ankara City Hospital
Local Ethic Committee with the number E1-21-1715.
Informed Consent: Patients were retrospectively analyzed.
Peer-reviewed: Externally peer-reviewed.
Authorship Contributions
Concept: F.C., İ.D., S.A., T.G., Design: F.C., İ.D., S.A., T.G., Data
Collection and Processing: F.C., İ.D., S.A., T.G., Statistical Analysis:
F.C., İ.D., S.A., T.G., Literature Search: F.C., İ.D., S.A., T.G., Writing:
F.C., İ.D., S.A., T.G.
Conflict of Interest: The authors declared no conflicts of
interest with respect to the authorship and/or publication of
this article.
Financial Disclosure: The authors received no financial
support for the research and/or authorship of this article.
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