Objective: The aim of this study is to evaluate the hematologic parameters and peripheral blood cell morphological changes in children with COVID-19 and compare them with those of children suspected but then confirmed to be negative for SARS-CoV-2.

Methodology: Thirty children were tested to be positive for SARS-CoV-2 and the remaining 40 were negative. Hemoglobin, leukocyte, neutrophil, lymphocyte, monocyte counts according to age-specific intervals, platelet, large unstained cell counts, and delta neutrophil index were recorded. Differential counts were formulated by manual counting and morphology of the blood cells were evaluated.

Results: The mean leukocyte counts of the SARS-CoV-2 positive and negative groups were 7.0±3.7×109/L and 10.4±7.1×109/L, respectively (p<0.05). Nine (30%) children with COVID-19 had lymphopenia. Among children with COVID-19, absolute lymphocyte count was lower in those with pneumonia (p<0.05). Reactive lymphocytes were noted in 77.8% and 90% in the SARS-CoV-2 test positive and negative groups, respectively (p>0.05). Mean absolute neutrophil counts of the SARS-CoV-2 test positive and negative groups were 3.7±2.9×109/L and 5.4±4.2×109/L (p<0.05). Four patients (13.3%) with SARS-CoV-2 test positive had neutrophilia and seven (23.3%) had mild neutropenia. In the peripheral smear, vacuolated monocytes and dysplastic changes in neutrophils and platelets were noted in both groups.

Conclusion: Leukocyte, neutrophil and monocyte counts were significantly lower in children with COVID-19 compared with symptomatic children without COVID-19. Lymphopenia, reactive lymphocytosis and dysplasia, could be noted in children with COVID-19. Further studies on hematological findings linked with the course of the disease in children are warranted.