Objective: To examine morphology of white blood cells on peripheral blood smears (PBSs) of confirmed COVID-19 (Corona Virus Disease-19) patients with moderate to severe disease. Materials and Methods: Prospective study was conducted for a period of 3 months from May 2021 to July 2021 at dedicated tertiary care COVID-19 hospital in Northern India, where Giemsa-stained PBSs from 170 COVID-19 positive patients with moderate to severe disease were examined microscopically for morphological changes in white blood cells. Statistical analysis: The qualitative data was analyzed using chi squared test. The confidence interval was set to 99%, the p-value was considered significant at the level of <.01. Results: On microscopic examination of PBSs, most frequent finding was neutrophilia (64.1% of total cases) and was seen in 100% of patients with severe COVID-19 disease (p value <0.01). The morphological changes seen in neutrophils were hypolobation, pseudo-pelger-huet anomaly (p value<0.01), shift to left (p value <0.01), apoptotic bodies, hypogranularity and leukoerythroblastic blood picture. Atypical lymphocytes were seen in moderate COVID-19 disease amounting to 8.2% of total cases. Vacuolated reactive monocytes were observed in 13.5% of total cases. Conclusion: In our study a relevant number of moderate to severe cases of COVID- 19 showed neutrophilia, pseudo-pelger-huet anomaly and shift to left on peripheral blood smear. Hence it may be assumed from the study that neutrophilia and morphological findings from PBSs in COVID-19 disease can alert the physician of an impending disease progression.