Abstract
Background:
Coronavirus disease 2019 (COVID-19) is a viral respiratory infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The inflammatory conditions and immune state of patients clearly play a role in defining the course of illness development.

Aim:
This study aimed to assess the effect of COVID-19 on acute-phase proteins (APPs) and the hematological findings in Libyan patients with COVID-19 by studying the role of APP levels and their correlation with sex and age, as well as hemoglobin and iron levels. Correlation of changes in APPs with hematological changes regarding COVID-19 status and severity, as well as study MDA concentration in patients with COVID-19.

Methods:
Data was collected from medical records for this study of 1161 mild cases admitted to the "outpatient department (OPD)" in Zawiat Al Dahmani Health Center (Tripoli, Libya) were collected. In addition, venous blood samples were collected from 150 cases. Of these, 81 cases were evaluated as severe cases, while another 69 cases were labeled as "controls" (negative for COVID-19) at the Preventive Medicine Hospital (Matiga Isolation Center, Tajura, Libya). Concentrations of C-reactive protein (CRP), lactate dehydrogenase (LDH), D-dimer, and albumin were measured using the COBAS Integra 400 Plus. Concentrations of serum ferritin and iron profiles (serum iron, TIBC, and UIBC) were measured using COBAS 411e. Additionally, a complete blood count (CBC) was performed using a Sysmex XP-300TM Automated Hematology Analyzer. The ESR was measured using the Westergren method. The serum levels of MDA as a lipid peroxidation marker were estimated using the TBARS assay.

Results:
The results revealed a significant increase in CRP (P <0.001), ferritin (P <0.001), and ESR (P <0.001) levels in the severe group compared with the mild and control groups. also decreased albumin (P <0.001) in the severe group compared with the mild and control groups in males and females. In contrast, in the young-adult age group, the results show no statistically substantial variance (p-value > 0.05) was observed between the studied groups (severe, mild, and control groups) with regard to CRP and ferritin, whereas increased ESR levels (P< 0.001) were observed in the severe group compared with the mild and control groups. In contrast, a highly statistically significant (P <0.001) decrease in albumin was observed in the severe group compared with the mild and control groups. In the adult and elderly age groups, as compared to the mild group and control group, statistically significant (p-value 0.001) increases in CRP, ferritin, and ESR were observed in the severe group; in contrast, a highly statistically significant (p-value < 0.001) decrease in albumin was observed in the severe group compared with the mild and control groups.

Conclusion:
COVID-19 causes changes in hematological parameters, such as lymphocytes, white blood cells, platelets, neutrophils, and other blood cells, depending on disease severity. Our results showed that systemic inflammation may play a role in determining the severity of COVID-19 illness and mortality.

Key words: Acute-Phase Proteins, COVID-19, Hematological parameters, Libya