Characterization of Hematological Changes and Coagulopathy Patterns in Iraqi Patients with Post-COVID-19 Syndrome

Background: A Complex Multisystem Disorder Representing A Significant Proportion Of COVID-19 Survivors Emerging evidence indicates that persistent hematological abnormalities and coagulopathy may play a role in the pathophysiology of long COVID symptoms. However, existing data document limited information on the prevalence and patterns of hematological abnormalities in residents of the Middle East, especially Iraq. Objectives: The objectives of this study are to investigate the hematological changes and the patterns of coagulopathy in patients from Iraq who have presented to private clinics in Baghdad with post-COVID-19 syndrome, and to evaluate the risk factors associated with the identified hematological abnormalities. Methods: A cross-sectional survey was conducted at National centre of teaching laboratories / Baghdad medical city between January 2023 and December 2023. We included a sample of 312 patients meeting the World Health Organization (WHO) criteria for post-COVID-19 syndrome; symptoms persisting beyond 12 weeks after acute infection. Complete Blood Counts, Coagulation Profiles, D-dimer levels, Fibrinogen levels, and inflammatory markers were all assessed using comprehensive hematological analysis. The data collected from the above tests were analyzed using appropriate statistical methods, and a p-value of <.05 was considered statistically significant. Results: The average age of respondents to the survey was 47.3 (13.8 SD), with 58.3% female respondents. Hematological abnormalities were identified in 67.3% of the sample; some of the most prevalent included elevated D-dimer levels (62.5%), lymphopenia (43.6%), elevated fibrinogen levels (38.1%), and thrombocytopenia (28.2%). Factors significantly associated with persistent hematological abnormalities included the severity of the initial COVID-19 infection and the presence of chronic co-morbidities and prolonged duration of symptoms (p<0.01). Respondents reporting severe fatigue and dyspnea had significantly higher levels of D-dimer than those with mild fatigue and dyspnea (p<0.001). Conclusion: Our survey indicated that there is a high prevalence of persistent hematological abnormalities and hypercoagulability in Iraqi patients presenting with post-COVID-19 syndrome. Continued inflammation and hypercoagulability may be contributing factors to the pathophysiology of long COVID. Extended hematological assessments and/or anticoagulant therapy may be of value to this group of patients. Further prospective longitudinal studies are needed to determine the most effective treatment for this group.