Erythrocyte morphology as a clinical disease indicator in hospitalized COVID-19 patients

Authors

  • Berina Hasanefendić Department for Laboratory technologies, Faculty of Health Studies, University of Sarajevo, Sarajevo, Bosnia and Herzegovina https://orcid.org/0000-0002-9610-5020
  • Ermin Begović Clinical Biochemistry and Immunology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina https://orcid.org/0000-0002-6785-4428
  • Emir Šeherčehajić Department for Laboratory technologies, Faculty of Health Studies, University of Sarajevo, Sarajevo, Bosnia and Herzegovina https://orcid.org/0000-0002-8561-5439
  • Suzana Tihić-Kapidžić Clinical Biochemistry and Immunology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina https://orcid.org/0000-0002-8064-7650
  • Lajla Halilović Clinical Biochemistry and Immunology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
  • Jasmina Fočo-Solak Clinical Biochemistry and Immunology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
  • Sanela Hajro Department for Laboratory technologies, Faculty of Health Studies, University of Sarajevo, Sarajevo, Bosnia and Herzegovina https://orcid.org/0000-0002-5302-5864
  • Aleksandra Pašić Department for Laboratory technologies, Faculty of Health Studies, University of Sarajevo, Sarajevo, Bosnia and Herzegovina https://orcid.org/0000-0001-8588-8042
  • Amir Fazlagić Clinical Biochemistry and Immunology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
  • Ahmed Velić Clinic for Infectious Diseases, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
  • Lejla Ibričević-Balić Clinic for Hematology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina https://orcid.org/0009-0009-7983-8941
  • Lamija Zečević-Pašić Clinical Biochemistry and Immunology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina https://orcid.org/0000-0003-1110-0675

DOI:

https://doi.org/10.3855/jidc.20397

Keywords:

SARS-CoV-2, COVID-19, red blood cells, peripheral blood smear

Abstract

Introduction: Most COVID-19 cases are mild, but some require hospitalization due to pneumonia, with symptoms like hypoxia and dyspnea. This has led to speculation about erythrocyte involvement in the infection. This study aimed to examine the differences in the presence of dysmorphic erythrocytes in COVID-19 patients upon admission compared to healthy subjects, as well as to assess these differences in relation to the severity of the clinical presentation of COVID-19.

Methodology: This study included 150 participants: 100 COVID-19 patients and 50 healthy subjects who formed the control group. The COVID-19 positive participants were divided into two groups based on the deterioration or improvement of their health conditions during hospitalization. Hematological parameters were analyzed, and peripheral blood smears were prepared to observe morphological changes in erythrocytes.

Results: The morphological changes observed in hospitalized COVID-19 patients included spiculated red blood cells (RBCs), spherocytes, stomatocytes, schistocytes, knizocytes, keratocytes, as well as mushroom- and cup-shaped RBCs. At admission, spiculated RBCs and spherocytes were more prevalent in patients showing improvement. Conversely, stomatocytes, knizocytes, keratocytes, and mushroom-shaped RBCs were more frequent in patients experiencing deterioration. Additionally, spiculated RBCs were more common in patients with improvement, while stomatocytes, schistocytes, knizocytes, keratocytes, mushroom-, and cup-shaped RBCs were more prevalent in deteriorating patients.

Conclusions: The complete blood count and the examination of peripheral blood smears in hospitalized patients may serve as fundamental tools to assist clinicians in differentiating disease severity and improving treatment decision-making.

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Published

2025-10-31

How to Cite

1.
Hasanefendić B, Begović E, Šeherčehajić E, Tihić-Kapidžić S, Halilović L, Fočo-Solak J, Hajro S, Pašić A, Fazlagić A, Velić A, Ibričević-Balić L, Zečević-Pašić L (2025) Erythrocyte morphology as a clinical disease indicator in hospitalized COVID-19 patients. J Infect Dev Ctries 19:1443–1454. doi: 10.3855/jidc.20397

Issue

Vol. 19 No. 10: October 2025

Section

Coronavirus Pandemic

License

Copyright (c) 2025 Berina Hasanefendić, Ermin Begović, Emir Šeherčehajić, Suzana Tihić-Kapidžić, Lajla Halilović, Jasmina Fočo-Solak, Sanela Hajro, Aleksandra Pašić, Amir Fazlagić, Ahmed Velić, Lejla Ibričević-Balić, Lamija Zečević-Pašić

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