Exploring Hematological Parameters and Their Prognostic Value in Adult COVID-19 Patients: Insights from Mogadishu, Somalia

There were no data on SARS-CoV-2 and hematology in Mogadishu, Somalia, despite the fact that many prior investigations of SARS-CoV-2 and hematology have already been conducted in many different parts of the world. As a result, this study aimed to assess hematological changes in COVID-19-infected patients at some selected hospitals in Mogadishu, Somalia. Methods. Outright, 433 COVID-19 patients were included in this study, which used a hospital-based cross-sectional design to investigate hematological alterations using the Mindray full automated hematological analyzer. Furthermore, ethical considerations were taken into account during the study. All individuals provided informed consent prior to participation in the study. Data were analyzed using SPSS. Results. The median age of the current study was 54.65 ± 20.486 years. People with diabetes, high blood pressure, asthma, or heart disease made up 21.2%, 21.2%, 20%, and 2.1% of the study population, respectively. According to the patients' hematological profiles, 89.5% of them had leukopenia, 86.8% had lymphopenia, and 89% had neutrophilia. Monocytes, eosinophils, basophils, and thrombocytes were typically normal although around 50.4% individuals exhibited anemia. Conclusion. Hematological indicators can predict how bad the illness is and how it will turn out, which helps guide clinical therapy. Leukopenia, neutrophilia, lymphopenia, and anemia were found in this study. At the time of admission, a thorough review of laboratory parameters can help clinicians make a treatment plan and quickly give intensive care to the patients who need it most.


Introduction
Since December 2019, a global pandemic has been caused by the coronavirus disease 2019 (COVID-19)-infected pneumonia [1,2].Globally, 13,150,645 patients were infected as of July 15, 2020, with 574,464 deaths confrmed by WHO (Novel Coronavirus) [3].COVID-19's natural reservoir and intermediate host have yet to be described, but laboratory evidence of infection with a related coronavirus has been found in several wildlife species, including bats and pangolins [4].Emerging data suggest that COVID-19 should be viewed as a systemic disease involving multiple systems, including the cardiovascular, respiratory, gastrointestinal, neurological, hematopoietic, and immune systems.Although it is well known that COVID-19 primarily manifests as a respiratory tract infection [5], the studies on patients with COVID-19 have found some variations in their hematologic and immunologic indices.It was discovered that the disease's acute stage was characterized by signifcant lymphopenia and a sharp loss of CD4+ T and CD8+ T cells.Te relationship between anomalies in laboratory indices such as leukocyte, lymphocyte, and eosinophil counts, serum infammatory cytokine levels, and the severity or mortality of the diseases has been examined in several research studies on SARS-CoV, 11 MERS-CoV, 12, or SARS-CoV-213 infections [6].
Tere were no data on SARS-CoV-2 and hematology in Mogadishu, Somalia, despite the fact that many prior investigations of SARS-CoV-2 and hematology have already been conducted in many diferent parts of the world.To the best of our knowledge, no particular research on SARS-CoV-2 and hematology has been conducted in Mogadishu, Somalia.As a result, this study aimed to assess hematological changes in COVID-19-infected patients at some selected hospitals in Mogadishu, Somalia.Te research can provide context-specifc information, contribute to scientifc knowledge, and potentially inform clinical practice in the management of COVID-19 in similar settings.Tis study will allow for a localized investigation of hematological parameters in COVID-19 patients, taking into account the unique population characteristics and resource limitations.

Study Design and Populations.
A hospital-based crosssectional study was carried out at some selected hospitals in Mogadishu, Somalia, to assess hematological parameters among COVID-19 patients.Te study is undertaken between December 1st, 2020, and March 30th, 2021.Patients experiencing respiratory symptoms are chosen to take part in this study.Approximately 433 inpatients and outpatients were selected for the study after excluding anyone who denied participation.

Data Collection Tools and
Procedures.An alreadystructured questionnaire was used to obtain information from patients experiencing respiratory problems.Trained health professionals in some selected hospitals collected sociodemographic factors and COVID-19-related clinical data.Tere was strict confdentiality about the information provided on the questionnaires, and the data were doublechecked daily to ensure accuracy.

Sample Collection
. About 5 ml of blood samples were drawn from study participants using an EDTA (ethylenediaminetetraacetic acid, containing vacutainer tube) for analysis of hematological parameters.

Sociodemographic Characteristics of Study Participants.
In the present study, a total of 433 people participated, 57.3% of whom were male and 42.7% female.Te average age of participants was 54.65 years old, with a standard deviation of 20.486.Most of the participants (83.4%) were married, with the rest (16.6%) being single.Of the participants, 76.2% were educated and possessed a high school diploma, while 23.8% were not educated.Employment-wise, 78.5% of the participants were employed and 21.5% were unemployed.Out of the participants, 91.7% were not smokers and 8.3% were smokers (Table 2).

Hematological Characteristics of Study Participants.
Tis study provided unique insights into the numerous blood parameters of COVID-19 patients, both severe and nonsevere.Let us examine and expand these fndings: the study found that patients with severe COVID-19 had signifcantly lower amounts of RBCs, Hb, and Hct than those with nonsevere instances.A decrease in these parameters, which are important components of the blood that are crucial for oxygen transport and overall health, could indicate anemia or decreased oxygen-carrying capacity.Tis fnding may indicate the severity of the impact of the disease on the general physiological function of the body.Te study also discovered that the majority of patients' mean cell volume, which measures the size of red blood cells, was within the normal range.Tis shows that sickness had little 2 Advances in Hematology efect on the size of red blood cells.Tis part of the data could imply that despite the severity of COVID-19 infection, certain characteristics of the red blood cell population remained relatively steady.In individuals with severe COVID-19, leukopenia (lower white blood cell count) and lymphocytopenia (lower count of a specifc type of white blood cell, called lymphocytes) were particularly common.
Tese fndings indicate that the body's immune response is disrupted, potentially leaving patients exposed to infections due to a reduced defense system.Tis could be related to the severity of the disease and its impact on the ability of the immune system to combat infections.It is interesting to note that patients with severe COVID-19 exhibit a large increase in neutrophils, a diferent type of white blood cell.A vigorous infammatory response in the body, possibly as a result of the immune system's attempt to fght the infection, can be indicated by neutrophilia.However, severe infammation can also cause tissue damage, which may increase disease severity.Other types of white blood cells, such as monocytes, eosinophils, and basophils, were within the normal range in individuals with severe COVID-19.Tis could imply that the severity of sickness had no efect on the specifc components of the immune system response.Interestingly, the majority of COVID-19 patients had normal thrombocyte (platelet) numbers.Platelets are essential for blood clotting and wound healing.Tis fnding implies that patients with severe COVID-19 did not consistently demonstrate abnormalities in platelet counts.However, even with normal platelet counts, it is important to investigate whether platelet function is impaired (Table 4).Advances in Hematology 50.1% of SCP and 50.4% of NSCP exhibit low counts, while erythrocytosis is observed in 30.5% of SCP and 30.6% of NSCP.Normal erythrocyte counts are found in 19.4% of SCP and 19.0% of NSCP.Similarly, there is no signifcant diference in erythrocyte levels between SCP and NSCP.Analysis of hematocrit levels reveals that 62.6% of SCP and 63.4% of NSCP fall into the low category, while high hematocrit is observed in 18.7% of SCP and 18.2% of NSCP.Normal hematocrit levels are present in 18.7% of SCP and 18.4% of NSCP.Hematocrit levels also do not show a signifcant diference between SCP and NSCP.

Regression
With regard to leukocyte counts, 28.6% of SCP and 89.5% of NSCP exhibit leukopenia, while leukocytosis is seen in 7.4% of SCP and 90.6% of NSCP.Normal leukocyte counts are found in 63.9% of SCP and 88% of NSCP.Interestingly, there is a notable diference in leukocyte levels.SCP patients are more likely to have leukopenia, while NSCP patients are more likely to have leukocytosis.Concerning neutrophil levels, neutropenia is observed in 2.5% of SCP and 63.6% of NSCP, while neutrophilia is noted in 74.6% of SCP and 89% of NSCP.Normal neutrophil counts are present in 22.9% of SCP and 90.9% of NSCP.Neutrophil levels also show a signifcant diference.SCP patients are more likely to have neutrophilia, while NSCP patients are more likely to have neutropenia.Regarding lymphocyte levels, lymphopenia is prevalent in 78.8% of SCP and 86.8% of NSCP, while lymphocytosis is observed in 8.8% of SCP and 92.1% of NSCP.Normal lymphocyte counts are found in 12.5% of SCP and 88.9% of NSCP.Lymphocyte levels show a signifcant diference.SCP patients are more likely to have lymphopenia, while NSCP patients are more likely to have lymphocytosis.

Discussion
Te current study involved a total of 433 participants, with 57.3% males and 42.7% females.Te mean age of the participants was 54.65 ± 20.486 years.Te majority of the participants were married (83.4%), while 16.6% were single.In terms of education, 76.2% of the participants were educated, while 23.8% were uneducated.Regarding employment status, 78.5% of the participants were employed, while 21.5% were unemployed.Te majority of the participants were nonsmokers (91.7%), while 8.3% were smokers (see Table 2).According to these fndings, the study participants were mostly middle-aged and married, with a higher number of males than females.Te high proportion of educated participants indicates that the sample was diversifed and had a good representation of various educational backgrounds.It is worth noting that a sizable proportion of the individuals was working, implying a potential link between employment status and the health outcome under investigation.Furthermore, the high proportion of nonsmokers in the sample could be attributed to growing public awareness of the negative health efects of smoking.Te study was carried out by the authors in [7].Te mean age was lower than our study, and the COVID-19 patients who were admitted was 48.798 ± 8.53 years.Another study was carried out by the authors in [8].Te median age of 201 patients was 51 years, and 128 (63.7% of the total) were men.In addition to another study [9], a total of 52 patients were included in the study, with a mean age of 59.7 (standard deviation of 13.3) years and a prevalence of men of 67%.
Te outcomes of this study provide crucial insights into the comorbidities present in COVID-19 patients.According to the fndings, a large proportion of COVID-19 patients had preexisting medical disorders, with diabetes and hypertension accounting for 21.2% each and asthmatic patients accounting for 20%.It should be noted that the prevalence of 4 Advances in Hematology cardiac comorbidities was rather low, at only 2.1% (see Table 3).Tese fndings emphasize the importance of understanding the underlying health status of COVID-19 patients.Diabetes and hypertension are two preexisting illnesses that may enhance the risk of severe sickness and consequences from COVID-19.Terefore, minimizing the efects of COVID-19 on these patients may require early detection and management of comorbidities.Te authors in [7] discovered that diabetic, hypertensive, asthmatic, and cardiac comorbidities accounted for 68%, 73%, 35%, and 3%, respectively.In addition [10], they discovered diabetes (12.50%), hypertension (20.59%), asthma (8.09%), and cardiac issue (30.88%).Te study carried out by the authors in [11] identifed hypertension (19% versus 23.2%), diabetes (9% versus 10.9%), chronic obstructive pulmonary disease (COPD) (3% versus 8.6%), and cardiovascular disease (6% versus 1.8%).In a study conducted by [12], the 95% confdence intervals for hypertension, diabetes, cardiovascular, cerebrovascular, and respiratory diseases in patients with severe cases were 2.79 (95% CI: 1.66-4.69),1.64 (95% CI: 2.30−1.08),1.79 (95% CI: 1.08-2.96),3.92 (95% CI: 2.45-6.28),and 1.98 (95% CI: 1.26-3.12),respectively.Another study carried out by the authors in [9] found that 91 (48%) patients had a comorbidity, with coronary heart disease (15 (8%) patients), diabetes (36 (19%) patients, and hypertension (58 (30%) patients) being the most prevalent.Te erythrocytes, hemoglobin, and hematocrit levels were lower in severe COVID-19 patients than in nonsevere COVID-19 patients (63.6%, 50.4%, and 63.4%, respectively), but the mean cell volume was normal in the vast majority of patients (73.8%).Leukopenia and lymphocytopenia were seen in 89.5% and 86.8%, respectively, in the severe COVID-19 patients.Neutrophilia, on the other hand, was considerably greater in patients with severe COVID-19 (89%).In the severe COVID-19 patients, monocytes (94.9%), eosinophils (88.7%), and basophils (91.55%) were all within normal norms.In 87.3% of the study, participants had normal thrombocyte levels.Te fndings of this study show that there are substantial disparities in hematological parameters between COVID-19 patients who are severe and those who are not.Severe COVID-19 patients, in particular, had lower red blood cell, hemoglobin, and hemocrit levels than nonsevere patients.Tis shows that severe COVID-19 cases may be associated with anemia, which may contribute to the disease's severity.Furthermore, the study discovered that leukopenia and lymphocytopenia were more common in severe COVID-19 patients, indicating a possible immune system compromise.Neutrophilia, on the other hand, was According to a study by [13], COVID-19 individuals exhibit thrombocytopenia (36.2%) and lymphopenia (83.2%); this study disagrees our study which found normal platelet in the majority of the patients.In addition, the study done by the authors in [14] discovered that the majority of patients had a normal CBC upon admission (normal Hb, WBC, and platelet count).In addition, none of the patients displayed moderate or severe thrombocytopenia, which is typically seen in other viral diseases like the prevalent dengue fever in our area.However, lymphopenia was seen in 28% of all patients.According to the study carried out by the authors in [15], majority of the patients had signifcantly higher neutrophil (NEU) counts (p � 0.0001) and lower white blood cell (WBC) counts (p � 0.0001).
A limitation of our study is the use of only some hematological parameters, such as the complete blood count.In addition, the number of samples collected was limited due to a relative lack of funds and the short duration of data collection.Te generalizability of the fndings may be limited due to the sample's geographical restriction to Mogadishu, which may not fully represent the entire pregnant population in Somalia.In order to facilitate future investigations, we suggest conducting a complete blood count test followed by a confrmatory test or employing an advanced technique such as molecular techniques to understand the exact efect of SARS-CoV-2 on blood cells and coagulation parameters.
In conclusion, hematological indicators can predict how bad the illness is and how it will turn out, which helps guide clinical therapy.Leukopenia, neutrophilia, lymphopenia, and anemia were found in this study.At the time of admission, a thorough review of laboratory parameters can help clinicians make a treatment plan and quickly give intensive care to the patients who need it most.

Table 2 :
Sociodemographic characteristics of study participants.

Table 3 :
Comorbidities status of study participants.

Table 4 :
Hematological characteristics of study participants.

Table 6 :
Hematological parameters that can predict the severity of COVID-19 infection.