Hematological Indices in COVID-19 Patients with Rhinosinusitis Mucormycosis

Document Type : Original


1 Department of Parasitology and Mycology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Sinus and Surgical Endoscopic Research Center, Mashhad University of Medical Sciences Mashhad Iran.



Introduction: Rhinosinusitis mucormycosis (RM) is an invasive opportunistic fungal infection, especially among COVID-19 patients. The current study aimed to assess the peripheral blood hematological disorders of COVID-19 patients-associated RM.
Materials and Methods: During ten month, in two COVID-19 centers in Mashhad, Iran, from June 2021 to March 2022, eighty-three patients suspected of COVID-19 with rhinosinusitis or rhino-orbital mucormycosis participated in this study. The hematological indices of these patients were measured by independent sample T‐test or Mann-Whitney test for quantitative data, and the qualitative variables were analyzed using Chi-square or Fisher’s exact test in SPSS version 20 at a significance level of 0.05.
Results: Of the COVID-19 patients, 40 (48.2%) were affected by RM, and leukocytosis due to neutrophilia was observed in 30% of them. Leukocyte counts were normal in 10 (25%) patients, but 1 (2.5%) and 3 (7.5%) had leukopenia and lymphopenia, respectively. Leukocytosis plus lymphopenia was observed in 7 (17.5%) patients. Also, the synchronicity of leukopenia and lymphopenia was seen in 5 (12.5%) patients. Leukopenia, lymphopenia, and neutropenia have occurred concurrently in 2 (5%) patients. The complete blood count (CBC) showed that RBCs, hemoglobin (Hb), hematocrit (HCT), MCH, MCHC, platelet (PLT), and lymphocytes decreased while neutrophils increased.
Conclusion: Among the hematological parameters, leukocytosis due to neutrophilia and reduction in Hb, HCT, and PLT are more dominant factors in COVID-19 patients-associated RM.


Main Subjects

  1. Frater JL, Zini G, d’Onofrio G, Rogers HJ. COVID‐19 and the clinical hematology laboratory. International journal of laboratory hematology. 2020; 42:11-8.
  2. Zhou P, Liu Z, Chen Y, Xiao Y, Huang X, Fan X-G. Bacterial and fungal infections in COVID-19 patients: a matter of concern. Infection Control & Hospital Epidemiology. 2020;41(9):1124-5.
  3. Hosseinikargar N, Basiri R, Asadzadeh M, Najafzadeh MJ, Zarrinfar H. First report of invasive Aspergillus rhinosinusitis in a critically ill COVID‐19 patient affected by acute myeloid leukemia, northeastern Iran. Clinical case reports. 2021;9(10).
  4. Arastehfar A, Shaban T, Zarrinfar H, Roudbary M, Ghazanfari M, Hedayati M-T, et al. Candidemia among Iranian patients with severe COVID-19 admitted to ICUs. Journal of Fungi. 2021;7(4):280.
  5. Dolatabadi S, Ahmadi B, Rezaei-Matehkolaei A, Zarrinfar H, Skiada A, Mirhendi H, et al. Mucormycosis in Iran: A six-year retrospective experience. Journal de mycologie medicale. 2018; 28(2): 269-73.
  6. Mishra N, Mutya VSS, Thomas A, Rai G, Reddy B, Mohanan AA, et al. A case series of invasive mucormycosis in patients with COVID-19 infection. Int J Otorhinolaryngol Head Neck Surg. 2021; 7(5): 867-70.
  7. Kamat M, Datar U, Byakodi S, Kamat S, Kumar VV. COVID-19-associated mucormycosis of head-and-neck region: A systematic review. Journal of Clinical and Translational Research. 2022;8(1):31.
  8. Dogra S, Arora A, Aggarwal A, Passi G, Sharma A, Singh G, et al. Mucormycosis amid COVID-19 crisis: pathogenesis, diagnosis, and novel treatment strategies to combat the spread. Frontiers in microbiology. 2022;12:4005.
  9. Jeong W, Keighley C, Wolfe R, Lee WL, Slavin M, Kong D, et al. The epidemiology and clinical manifestations of mucormycosis: a systematic review and meta-analysis of case reports. Clinical microbiology and infection. 2019;25(1):26-34.
  10. Kashefi E, Seyedi SJ, Zomorodian K, Zare Shahrabadi Z, Zarrinfar H. Successful treatment of pulmonary aspergillosis due to Aspergillus fumigatus in a child affected by systemic lupus erythematosus: A case report from Northeastern Iran. 2021;9(5):e04248.
  11. Smith AC, Morran LT, Hickman MA. Host defense mechanisms induce genome instability leading to rapid evolution in an opportunistic fungal pathogen. Infection and Immunity. 2022; 90(2): e00328-21.
  12. Peeri NC, Shrestha N, Rahman MS, Zaki R, Tan Z, Bibi S, et al. The SARS, MERS and novel coronavirus (COVID-19) epidemics, the newest and biggest global health threats: what lessons have we learned? International journal of epidemiology. 2020; 49(3):717-26.
  13. Zarrinfar H, Makimura K, Satoh K, Khodadadi H, Mirhendi H. Incidence of pulmonary aspergillosis and correlation of conventional diagnostic methods with nested PCR and real‐time PCR assay using BAL fluid in intensive care unit patients. Journal of clinical laboratory analysis. 2013;27(3):181-5.
  14. Arjun R, Felix V, Niyas VKM, Kumar MAS, Krishnan RB, Mohan V, et al. COVID-19-associated rhino-orbital mucormycosis: a single-centre experience of 10 cases. QJM: An International Journal of Medicine. 2021; 114(11): 831-4.
  15. Veisi A, Bagheri A, Eshaghi M, Rikhtehgar MH, Rezaei Kanavi M, Farjad R. Rhino-orbital mucormycosis during steroid therapy in COVID-19 patients: A case report. European journal of ophthalmology. 2022;32(4):NP11-NP6.
  16. Ibrahim AS, Spellberg B, Walsh TJ, Kontoyiannis DP. Pathogenesis of mucormycosis. Clinical infectious diseases. 2012;54(suppl_1):S16-S22.
  17. Horiuchi Y, Hayashi F, Iwasaki Y, Matsuzaki A, Nishibe K, Kaniyu K, et al. Peripheral granular lymphocytopenia and dysmorphic leukocytosis as simple prognostic markers in COVID‐19. International journal of laboratory hematology. 2021; 43(6):1309-18.
  18. Taj S, Fatima SA, Imran S, Lone A, Ahmed Q. Role of hematological parameters in the stratification of COVID-19 disease severity. Annals of medicine and surgery. 2021;62:68-72.
  19. Jain K, Surana A, Choudhary TS, Vaidya S, Nandedkar S, Purohit M. Clinical and histology features as predictor of severity of mucormycosis in post-COVID-19 patients: An experience from a rural tertiary setting in Central India. SAGE Open Medicine. 2022;10:20503121221074785.
  20. Organization WH. Laboratory testing for 2019 novel coronavirus (2019-nCoV) in suspected human cases: interim guidance. Laboratory testing for 2019 novel coronavirus (2019-nCoV) in suspected human cases: Interim guidance2020. p. 7-.
  21. Zhang H, Cao X, Kong M, Mao X, Huang L, He P, et al. Clinical and hematological characteristics of 88 patients with COVID‐19. International journal of laboratory hematology. 2020;42(6):780-7.
  22. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. jama. 2020; 323(11): 1061-9.
  23. Lippi G, Mattiuzzi C. Hemoglobin value may be decreased in patients with severe coronavirus disease 2019. Hematology, transfusion and cell therapy. 2020;42:116-7.
  24. Liu J, Li S, Liu J, Liang B, Wang X, Wang H, et al. Longitudinal characteristics of lymphocyte responses and cytokine profiles in the peripheral blood of SARS-CoV-2 infected patients. EBioMedicine. 2020;55.
  25. Taneri PE, Gómez-Ochoa SA, Llanaj E, Raguindin PF, Rojas LZ, Roa-Díaz ZM, et al. Anemia and iron metabolism in COVID-19: a systematic review and meta-analysis. European journal of epidemiology. 2020;35:763-73.










































  1. Henry BM, De Oliveira MHS, Benoit S, Plebani M, Lippi G. Hematologic, biochemical and immune

biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis. Clinical Chemistry and Laboratory Medicine (CCLM). 2020; 58(7): 1021-8.

  1. Foy BH, Carlson JC, Reinertsen E, Valls RPI, Lopez RP, Palanques-Tost E, et al. Association of red blood cell distribution width with mortality risk in hospitalized adults with SARS-CoV-2 infection. JAMA network open. 2020;3(9):e2022058-e.
  2. Aydemir H, Piskin N, Akduman D, Kokturk F, Aktas E. Platelet and mean platelet volume kinetics in adult patients with sepsis. Platelets. 2015; 26(4):331-5.