title: Acute-phase response and the hypercoagulable state in pulmonary tuberculosis.
abstract: 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.
authors.affiliation: University of Cape Town Leukaemia Centre, MRC-UCT Liver Research Centre, Department of Medicine, Cape Town, South Africa.
authors.forename: S C
authors.initials: SC
authors.lastname: Robson
authors.forename: N W
authors.initials: NW
authors.lastname: White
authors.forename: I
authors.initials: I
authors.lastname: Aronson
authors.forename: R
authors.initials: R
authors.lastname: Woollgar
authors.forename: H
authors.initials: H
authors.lastname: Goodman
authors.forename: P
authors.initials: P
authors.lastname: Jacobs
mesh_terms: 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*
chemical_list: D017395:Plasminogen Activator Inhibitor 1; D012709:Serum Albumin; D000990:Antithrombin III; D005340:Fibrinogen; D010959:Tissue Plasminogen Activator