title: Enhanced thrombin formation and fibrinolysis during acute Puumala hantavirus infection.
abstract: BACKGROUND
  Nephropathia epidemica (NE) is a viral hemorrhagic fever with renal syndrome associated with thrombocytopenia and mild bleeding. We assessed activation of coagulation and fibrinolysis during the acute phase of NE.
  
  
  METHODS
  19 hospital-treated patients were involved. Plasma levels of D-dimer, prothrombin fragments 1+2 (F1+2), activated partial thromboplastin time (APTT), prothrombin time (PT%), thrombin time (TT), fibrinogen, antithrombin (AT), protein S free antigen (PS), protein C (PC) and complete blood count (CBC) were measured three times during the acute phase and once at 32-54 days after the onset of fever (recovery phase). Laboratory abnormalities were evaluated by the disseminated intravascular coagulation (DIC) scoring advocated by the International Society of Thrombosis and Haemostasis (ISTH).
  
  
  RESULTS
  APTT was prolonged and D-dimer and F1+2 increased during the acute phase of NE. AT, PC and PS decreased, and TT was shortened, all implying increased thrombin generation. Acutely F1+2 was 3.4-fold and D-dimer even 24-fold higher compared with the recovery phase (median 726 vs 213 pmol/l, and median 4.8 vs 0.2mg/l, respectively, p<0.001 for both). Platelet count correlated with AT, PC, and PS (r=0.73, r=0.81, and r=0.71, respectively, p<0.001 for all) as well as with fibrinogen (r=0.72, p<0.001). Only five patients fulfilled the ISTH diagnosis of DIC.
  
  
  CONCLUSIONS
  During acute NE thrombocytopenia was associated with decreased natural anticoagulants, shortened thrombin time and enhanced fibrinolysis. Augmented thrombin formation and fibrinolysis characterize this hantavirus infection.
authors.affiliation: Department of Internal Medicine, Tampere University Hospital, Tampere, Finland. outi.k.laine@fimnet.fi
authors.forename: Outi
authors.initials: O
authors.lastname: Laine
authors.forename: Satu
authors.initials: S
authors.lastname: Mäkelä
authors.forename: Jukka
authors.initials: J
authors.lastname: Mustonen
authors.forename: Heini
authors.initials: H
authors.lastname: Huhtala
authors.forename: Timea
authors.initials: T
authors.lastname: Szanto
authors.forename: Antti
authors.initials: A
authors.lastname: Vaheri
authors.forename: Riitta
authors.initials: R
authors.lastname: Lassila
authors.forename: Lotta
authors.initials: L
authors.lastname: Joutsi-Korhonen
mesh_terms: D000328:Adult; D001777:Blood Coagulation; D001780:Blood Coagulation Tests; D004211:Disseminated Intravascular Coagulation / Q000150:complications; D005260:Female; D005342:Fibrinolysis; D006480:Hemorrhagic Fever with Renal Syndrome / Q000097:blood* / Q000150:complications; D054884:Host-Pathogen Interactions; D006801:Humans; D008297:Male; D008875:Middle Aged; D029262:Puumala virus / Q000502:physiology*; D013917:Thrombin / Q000378:metabolism*
chemical_list: D013917:Thrombin