Dear Readers and Colleagues,
On March 12, 2020, when there were in the world more than 118,000 cases of COVID-19 infection in 114 countries, and 4,291 people have lost their lives, the President of OMS made the assessment that COVID-19 could be characterized as a pandemic. At present, this pandemic is spreading more and more. Today, May 7, 2020, the Confirmed cases are 3 634 172, the confirmed deaths are 251 446, the confirmed countries, areas or territories with cases are 212.
Reports from China, Europe, and North America are enormous, particularly in the fast form of a letter to Editors. On the contrary, data from Africa, most the countries of Asia and South America, are scarce. The Mediterranean Journal of Hematology has a good diffusion in these countries. Hence, our idea and ambition are to become the journal most informative of the spread of COVID-19 in these countries. Therefore I invite all the readers of our Journal, working as doctors or nurses, treating in the hospital or at home, patients with COVID-19 infection, to send a Letter to the Editor in Chief of the MJHID, email@example.com, to inform their clinical and laboratory experience. The Editor will provide to put free online in the site of the journal their scientific contribution when considered valid for the knowledge of this disease in their country. The letter to the Editor (no more than 1000 words) should be written according to the author- guideline of the Journal. At the end of this year, the best letters, reviewed by the authors on the suggestion of talented reviewers, could be published online in a supplementary issue covered by PUBMED and possibly by Web of Science.
Looking forward to your participation in this initiative.
Editor in Chief
Letters to the Editor about COVID-19 published in the Mediterranean Journal of Hematology and Infectious Diseases, free online
Giuseppe Lassandro, Valentina Palladino, Viviana Valeria Palmieri, Anna Amoruso, Giovanni Carlo Del Vecchio, Paola Giordano
Elisabetta Abruzzese, Luigia Luciano, Francesco D'Agostino, Malgorzata Monika Trawinska, Fabrizio Pane, Paolo de Fabritiis
Giuseppe Vittorio De Socio, Lisa Malincarne, Saverio Arena, Stefania Troiani, Sara Benedetti, Barbara Camilloni, Giorgio Epicoco, Antonella Mencacci, Daniela Francisci
Romina Gallizzi, Diana Sutera, Francesca Mazza, Alessandra Spagnolo, Giovanni Battista Pajno
Marialaura Bonaccio, Licia Iacoviello, Maria Benedetta Donati, Giovanni de Gaetano
Maria Mazzitelli, Francesca Serapide, Bruno Tassone, Domenico Laganà, Enrico Maria Trecarichi, Carlo Torti
Seied Asadollah Mousavi, Soroush Rad, Tahereh Rostami, Mohammad Vaezi, Hosein Kamranzadeh, Davood Babakhani, Sahar Tavakoli, Maryam Barkhordar, Tanaz Bahri, Amirabbas Hedayatiasl, azade kiumarsi
Fehmi Hindilerden, Ipek Yonal-Hindilerden, Emre Akar, Zuhal Yesilbag, Kadriye Kart-Yasar
Claudio Ucciferri, Barone Mirko, Jacopo Vecchiet, Katia Falasca
The foloowing letter are not published in the MJHID and could be discussed by the readers of MJHID
Letter to Editor
Not ONLY COVID-19! The utility of peripheral blood smear at the time of Covid-19.
Di Matola Tiziana1 , Sale Silvia1, Boenzi Rita1, Landi Giuseppe1, D’antonio Anna1, Sabatino Rocco1, Vaccaro Maria Rosaria1, Atripaldi Luigi1
1 AORN Ospedali dei Colli - Ospedale Monaldi, UOC Biochimica Clinica, Napoli, Italia
Mail autori: di matola tiziana: firstname.lastname@example.org (corresponding author; silvia sale: email@example.com; atripaldi luigi : firstname.lastname@example.org; sabatino rocco: email@example.com; vaccaro mariarosaria : firstname.lastname@example.org, landi giuseppe : email@example.com ; d'antonio anna : firstname.lastname@example.org, boenzi rita : email@example.com
A routine blood count was performed on a 59 year-old man admitted to our hospital and affected by covid-19 pneumonitis. Blood count performed with DASIT XN 1000 showed that his hemoglobin concentration (Hb) dropped to 84g/L, the platelet count was 136×109/L, the lymphocytes count was 2,50x109/L  . The automated instrument output showed the presence of cells with increased fluorescence and reduced complexity suggesting the presence of plasmacytoid lymphocytes / plasmacells. Flow cytometric immunophenotyping showed expression of CD38, CD138, CD56, CD19, while CD20 and CD45 were negative . At biochemical parameters evaluation, increased LDH, Creatinine and PCR were observed. Monoclonal peak in the gamma zone was detected. The peripheral blood smear confirmed the presence of medium-sized plasmacells, strongly basophilic cytoplasm with pink tinge for an accumulation of immunoglobulins, paranuclear arcoplasma, eccentric nucleus with condensed clod chromatin (Fig.1). There was no clinical history of hematological disease and further investigations were necessary for diagnosis to confirm a coexisting multiple mieloma. The patient was then directed to oncology department to perform a bone marrow biopsy.
Observation of blood smear is important in the evaluation of abnormal cells shown by automatic analyzers. During the Cov-19 pandemic, in the presence of numerous morphological changes on the peripheral blood film the laboratory hematologist should be much more cautious to the possible coexistence of hematological pathology still unrecognized in affected patients .
- Zini G , Bellesi S, Ramundo F, d'Onofrio G. Morphological anomalies of circulating blood cells in COVID-19. Am J Hematol.2020 Apr 12. doi: 10.1002/ajh.25824. [Epub ahead of print]
- Rawstron AC, Orfao A, Beksac M, Bezdickova L, Brooimans RA, Bumbea H, Dalva K, Fuhler G, Gratama J, Hose D, Kovarova L, Lioznov M, Mateo G, Morilla R, Mylin AK, Omedé P, Pellat-Deceunynck C, Perez Andres M, Petrucci M, Ruggeri M, Rymkiewicz G, Schmitz A, Schreder M, Seynaeve C, Spacek M, de Tute RM, Van Valckenborgh E, Weston-Bell N, Owen RG, San Miguel JF, Sonneveld P, Johnsen HE; European Myeloma Network. Report of the European Myeloma Network on multiparametric flow cytometry in multiple myeloma and related disorders. 2008 Mar;93(3):431-8. doi: 10.3324/haematol.11080.
- He W, Chen L, Chen L, Yuan G, Fang Y, Chen W, Wu D, Liang B, Lu X, Ma Y, Li L, Wang H, Chen Z, Li Q, Gale RP. COVID-19in persons with haematological cancers. 2020 Apr 24. doi: 10.1038/s41375-020-0836-7. [Epub ahead of print]
Title: The impact of COVID-19 pandemic in the Mediterranean area: the experience of Sardinia
Andrea De Vito, Giordano Madeddu
Unit of Infectious and Tropical Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
Key words: COVID-19; pandemic; Mediterraean area; Sardinia
Prof Giordano Madeddu M.D.
S.C. Malattie Infettive e Tropicali Dipartimento di Scienze Mediche, Chirurgiche e Sperimentali; Università degli Studi di Sassari ; Viale San Pietro n. 35b;
07100 - SASSARI; ITALY; e-mail: firstname.lastname@example.org; ORCID ID: 0000-0001-6099-2273 phone n.: +39079213304
fax n.: +39079228781
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2), was identified in Wuhan (Hubei Province, China) in January 2020,and it belongs to betacoronaviridae. It is associated with high transmission rates because carriers could be both symptomatic and completely asymptomatic. The incubation period ranges between 2 and 14 days. SARS‐CoV‐2 infects, primarily the lung alveolar epithelial cells, causing pneumonia and, in severe cases, an Acute Respiratory Distress Syndrome (ARDS). Common clinical manifestations include fever, dyspnoea, and non-productive cough. Less frequently, asthenia and myalgia, dysgeusia, anosmia gastrointestinal symptoms, and cutaneous lesions are present[5-8]. Although Northern Italian regions have been sharply hit by Coronavirus disease 19 (COVID-19), southern Mediterranean regions, Sicily and Sardinia have also been affected by the disease even if with a lower burden. Fortunately, other Mediterranean areas, including Greece and north African countries, have shown limited spread of the disease and a low number of deaths.
As of 15th of May, 1348 COVID-19 cases with 125 deaths have been reported in Sardinia. Of these, 102 people have been admitted to the Unit of Infectious and Tropical Diseases of the University Hospital of Sassari. Sixty-seven (65.7%) were male with a median age of 74.5 (IQR 61.25-84) years. Symptoms were present in 94 (92.2%) patients. Fever was the most common symptom, present in 81 (79.4) patients, followed by dyspnoea, in 67 (65.7%) s, and cough in 42 (41.2%). Sore throat, anosmia, dysgeusia, and gastrointestinal symptoms were less commonly reported.
At the arterial blood gas examination, seventy-two (70.6%) patients had a pO2/FiO2 ratio under 300, requiring oxygen therapy. Of them, 40 (55.6) patients showed a severe respiratory failure, and they started an O2 treatment with a FiO2 > 40%, or they have been intubated. Twenty-seven (26.5) died, with a median time between the admission and the death of 6 (2.25-7) days.
Treatment included lopinavir/ritonavir, hydroxychloroquine, azithromycin, low molecular weight heparin, corticosteroids, and tocilizumab.
Our data show that more than 50% of cases hospitalized in our Unit presented with a severe respiratory failure upon admission. In contrast, most cases in our Region have not been admitted to hospitals and have been managed at home. This should be carefully taken into account, especially in middle and low-income countries, in which the possible impact of the COVID-19 on the health infrastructure could be devastating. All oral treatments for COVID-19 show some difficulties for home management. First of all, G6PDH deficiency should be ruled out before prescribing hydroxychloroquine, which also shows additive cardiac toxicity with azithromycin since both drugs can cause QT interval prolongation and significant arrhythmias. Lopinavir/ritonavir may induce QT prolongation and is known to inhibit cytochrome P450 3A4 and therefore interact with several medications, including antibiotics and psychiatric, cardiac, and lipid-lowering drugs.
Therefore, given the possibility of subsequent waves of COVID-19 cases in the upcoming months, there is a need rapidly to implement comprehensive home management units that should assure early detection of SARS CoV-2 infection and immediate isolation of patients and close contacts. COVID-19 treatment with easy to administered, effective, and with low drug-drug interactions, oral antivirals could represent a crucial tool in order to avoid disease progression, hospitalization, and possibly death.
- Rothe, C. et al. Transmission of 2019-NCOV infection from an asymptomatic contact in Germany. N. Engl. J. Med. 2020; 382: 970–971.
- Lauer, S. A. et al. The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application. Ann. Intern. Med. 2020; 172(9):577-582.
- Geng, Y.-J. et al. Pathophysiological Characteristics and Therapeutic Approaches for Pulmonary Injury and Cardiovascular Complications of Coronavirus Disease 2019. Cardiovasc. Pathol. 2020; 47, Published online ahead of print (2020).
- De Vito A, Geremia N, Fiore V, Princic E,Babudieri S, Madeddu G. Clinical features, laboratory findings and predictors of death in hospitalized patients with COVID-19 in Sardinia, Italy. Eur Rev Med Pharmacol Sci. 2020; In press.
- Vaira LA, Deiana G, Fois AG, Pirina P, Madeddu G, De Vito A, Babudieri S, Petrocelli M, Serra A, Bussu F, Ligas E, Salzano G, D. R. G. Objective evaluation of anosmia and ageusia in COVID-19 patients: a single-center experience on 72 cases. Head Neck In Press (2020).
- Zhou, F. et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 395, 1054–1062 (2020).
- Huang, C. et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 395, 497–506 (2020).
- Wang, D. et al. Clinical Characteristics of 138 Hospitalized Patients with 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA - J. Am. Med. Assoc. 323, 1061–1069 (2020).
- Coronavirus disease (COVID-19) Situation Report-116.
Covid-19 antibody tests and overestimation of seroprevalence rates
To the Editor:
The literature has been over saturated with reports of seroprevalence rates for Covid-19 ranging up to 44% in certain communities1 and up 5.2% in healthy blood donors2. In asymptomatic healthcare workers seroprevalence rates up to 17.1% were reported3. These results were based partially on early generation testing kits that had a high false positive rate or in other words having a low specificity. Some of the used kits did not have their specificity reported or had a relatively low specificity as indicated by the authors or kit manufactures. Some of the test manufacturers reported a high specificity rate based on a small number of validation samples.
The US Food and Drug Administration withdrew emergency use authorization for some of the testing kits based on their high false positive rates4.
Highly specific tests should be employed in testing populations with low prevalence rates to avoid overestimation of the real prevalence by high false positive rates. We used a test with a 100% sensitivity and a 99.8% specificity validated on a large number of samples to test healthy blood donors and asymptomatic healthcare workers at the King Hussein Cancer Center in Amman, Jordan. None of 746 blood donors nor 154 healthcare workers tested positive for the Covid-19 antibodies. This result was expected for both groups since blood donors were routinely screened for any exposure history and the healthcare workers do not deal with Covid-19 patients. Both groups are in a community with very low prevalence having just above 1000 confirmed cases in a population of 10 million.
Our conclusion is that many of the seroprevalence studies might have overestimated the real prevalence of Covid-19 by the use of less specific tests yielding higher false positive rates.
Maher A. Sughayer MD
Asem Mansour MD
Abeer Al Nuirat MSc
Lina Souan PhD
Mohammad Ghanem MSc
Mahmoud Siag BSc
King Hussein Cancer Center, Amman, Jordan
- Reifer J, Hayum N, Heszkel B, Klagsbald I, Streva VA. SARS-CoV-2 IgG Antibody Responses in New York City. medRxiv 2020.05.23.20111427; doi: https://doi.org/10.1101/2020.05.23.20111427
- Valenti L, Bergna A, Pelusi S, Facciotti F, Lai A, Tarkowski M, et al. SARS-CoV-2 seroprevalence trends in healthy blood donors during the COVID-19 Milan outbreak. medRxiv 2020.05.11.20098442
- Shields A, Faustini S, Perez-Toledo, M, et al. SARS-CoV-2 seroconversion in health care workers. MedRxiv 2020.05.18.20105197
- US Food and Drug Administration: FAQs on Testing for SARS-CoV-2: What Tests Should No Longer Be Distributed for COVID-19? https://www.fda.gov/medical-devices/emergency-situations-medical-devices/faqs-testing-sars-cov-2#nolonger, Accessed June, 24, 2020.