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Hemostatic derangement in leptospirosis: A prospective cross-sectional study
Rasa Threeswaran1, Nipun Lakshitha De Silva2, Lallindra Gooneratne3
1Department of Immunology, Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo, Colombo, Sri Lanka.
International Journal of Critical Illness and Injury Science
|December 30, 2020
Summary
Coagulation abnormalities are common in leptospirosis, with prolonged prothrombin time and activated partial thromboplastin time. Rotational thromboelastometry (ROTEM) parameters, however, showed no significant alterations in leptospirosis patients.
Area of Science:
- Infectious Diseases
- Hematology
- Critical Care Medicine
Background:
- Leptospirosis is associated with coagulation abnormalities, but severe cases lack detailed characterization.
- Understanding coagulopathy in leptospirosis is crucial for patient management.
Purpose of the Study:
- To evaluate conventional coagulation tests and rotational thromboelastometry (ROTEM) in patients with leptospirosis.
- To compare coagulation profiles between severe leptospirosis, mild leptospirosis, dengue, sepsis, and healthy controls.
Main Methods:
- Prospective cross-sectional study in Sri Lanka involving 14 severe leptospirosis, 6 mild leptospirosis, 6 dengue, 5 sepsis, and 6 healthy individuals.
- Assessed prothrombin time (PT), activated partial thromboplastin time (aPTT), thrombin time (TT), fibrinogen, lupus anticoagulant, factors VII and VIII, D-dimer, platelet count, and ROTEM.
- Statistical analysis included ANOVA with Bonferroni post hoc comparison.
Main Results:
- Leptospirosis patients exhibited prolonged PT and aPTT, which normalized with plasma.
- Fibrinogen was significantly elevated in severe leptospirosis and sepsis compared to controls and dengue.
- Thrombocytopenia occurred in 30% of leptospirosis patients (36% severe).
- ROTEM parameters (inTEM CT, exTEM CT) did not differ significantly across groups, while dengue showed altered clot formation and firmness compared to leptospirosis.
Conclusions:
- Conventional coagulation tests reveal abnormalities in leptospirosis patients.
- Rotational thromboelastometry (ROTEM) parameters do not appear significantly altered in leptospirosis, suggesting limited utility for characterizing coagulopathy in this disease.
