Hematological Findings in Pregnant Women With and Without Covid 19 Infection at the Nairobi Hospital Between 1st May 2021 and 31st August 2021.a Retrospective Comparative Cross-sectional Study

Abstract

Background: Coronavirus disease 2019 (COVID 19) is caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) which majorly affects the respiratory system. It was first discovered in Wuhan, Hubei Province and spread across China to the rest of the world. Given the novelty of the disease, there is limited data defining its effect in pregnancy. Globally the cases stand at 225,680,357 with 4,664,740 deaths to date. In Kenya the total cases as of September 2021 were 247,358 of which 7087 (2.9%) were in pregnancy. Currently no published statistics are available in Kenya on the hematological findings of COVID 19 in pregnancy. Pregnancy is associated with multiple physiological changes that make this population unique. During this pandemic of COVID 19, it has been shown that pregnant women are likely to be asymptomatic. However, they are more likely to develop severe disease form necessitating admission to the intensive unit. Pregnant COVID 19 patients have been shown to have significantly lymphocytopenia and thrombocytopenia but with elevated C-reactive protein, Ferritin levels, Interleukin 6, lactate dehydrogenase and procalcitonin and neutrophilia. Due to the limited data of COVID 19 in pregnancy basic hematological tests could be shared to the clinical health care workers because those presenting with hematological derangement are more likely to progress to more severe disease Objective: To determine the hematological findings in pregnant women in their 3rd trimester with and without COVID 19infection admitted at the Nairobi hospital from 1st May 2021 to 31 August 2021. Methodology: Using a comparative cross-sectional study design, data was retrieved from 60 files that met the inclusion criteria. The data Obtained was analyzed using SPSS version 26. Descriptive statistics such as the mean, standard deviation, counts and proportions were used to describe the study participant’s characteristics in tabulated form. The full hemogram results were first tabulated and compared across the 2 groups using Pearson’s Chi-square test/ Fisher’s exact test for categorical variables whereas T-test/ Wilcoxon signed rank test was used appropriately for numerical variables. The coagulation profile was determined, tabulated, and analyzed for any difference between the 2 groups using the appropriate test of comparison highlighted above. C reactive protein and LDH between the COVID 19 positive and negative gravid women was determined and tabulated using counts and percentages then compared using Chi-square/Fisher’s exact test appropriately. A p value of <0.05 was taken to show significance. Crude odds ratio with 95% CI was calculated Results: A total of 60 files were analyzed (30 COVID positive and 30 COVID negative. The mean age for the positive group and negative group was 33 and 31 years. Majority were employed in both groups (97% and 83%), urban dwellers (90% and 83%), vaccinated (83% and 97%), gestational age (38)and singleton pregnancy(93% and 97%).The odds of having neutropenia was 9.75 (2.71-35.11 95% CI in the COVID positive group with a p value of<0.001.Low hemoglobin of <10g/dl was in 60% of COVID positive mothers. The odds of having a prothrombin time of >12 seconds was 6.9 (1.16-11.10 95% CI) with a p value of 0.01.CRP and LDH were statistically significant in the COVID positive group with P values of 0.03 and <0.01.>LDH and> CRP were statistically significant in the COVID positive group and should be included in the diagnostic panel for the COVID 19 infection