Acute-phase response and the hypercoagulable state in pulmonary tuberculosis.
In our experience, severe pulmonary tuberculosis (PTB) is often complicated by deep venous thrombosis (DVT). Because of the association between inflammation and haemostatic changes that can result in a hypercoagulable state, we have prospectively examined such predisposing factors in representative patients. Sequential analyses in a control group with active PTB showed anaemia, thrombocytosis, elevations in plasma fibrinogen, fibrin(ogen) degradation products (FDP), tissue plasminogen activator (t-PA) and inhibitor (PAI-1) with depressed antithrombin III levels. Age, sex and disease matched individuals with venographically proven DVT had higher FDP (15.8 +/- 14.3 v 3.2 +/- 1.7 micrograms/ml:P < 0.01), t-PA (19.4 +/- 14.9 v 11.3 +/- 0.8 ng/ml:P < 0.01), and functional PAI-1 activity (11.6 +/- 6.3 v 4.2 +/- 4.1:P < 0.01) with lower platelet counts (347 +/- 110 v 563 +/- 230 x 10(9)/1:P < 0.01). Fibrinogen levels in all patients rose during the first 2 weeks of therapy and, together with related disturbances, corrected within 12 weeks. In conclusion, elevated plasma fibrinogen with impaired fibrinolysis coupled with a decrease in antithrombin III and reactive thrombocytosis would appear to favour the development of DVT in PTB.
Robson
S C
SC
University of Cape Town Leukaemia Centre, MRC-UCT Liver Research Centre, Department of Medicine, Cape Town, South Africa.
White
N W
NW
Aronson
I
I
Woollgar
R
R
Goodman
H
H
Jacobs
P
P
D000210:Acute-Phase Reaction / Q000097:blood / Q000209:etiology*; D000328:Adult; D000368:Aged; D000990:Antithrombin III / Q000378:metabolism; D001777:Blood Coagulation; D016022:Case-Control Studies; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D005342:Fibrinolysis; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017395:Plasminogen Activator Inhibitor 1 / Q000378:metabolism; D010979:Platelet Function Tests; D011446:Prospective Studies; D012709:Serum Albumin / Q000378:metabolism; D013924:Thrombophlebitis / Q000097:blood / Q000209:etiology*; D010959:Tissue Plasminogen Activator / Q000378:metabolism; D014397:Tuberculosis, Pulmonary / Q000097:blood / Q000150:complications*
D017395:Plasminogen Activator Inhibitor 1; D012709:Serum Albumin; D000990:Antithrombin III; D005340:Fibrinogen; D010959:Tissue Plasminogen Activator