Haemostatic Dysfunction in Lassa Fever: Implications for Disease Severity and Outcome
E. C. Okpunu
Department of Haematology, Ambrose Alli University, Ekpoma, Nigeria and Department of Haematology, Irrua Specialist Teaching Hospital, Irrua, Nigeria.
D. O. Olanrewaju
Department of Haematology, Irrua Specialist Teaching Hospital, Irrua, Nigeria and Department of Haematology and Blood Transfusion, Federal University of Health Science, Azare, Nigeria.
E. O. Dic-Ijiewere *
Department of Chemical Pathology, Ambrose Alli University, Ekpoma, Nigeria.
O. S. Otumu
Department of Haematology, Ambrose Alli University, Ekpoma, Nigeria and Department of Haematology, Irrua Specialist Teaching Hospital, Irrua, Nigeria.
O. A. Awodu
Department of Haematology, Ambrose Alli University, Ekpoma, Nigeria and Department of Haematology, University of Benin, Benin City, Nigeria.
C. C. Nwankwo
Department of Chemical Pathology, Ambrose Alli University, Ekpoma, Nigeria and Department of Chemical Pathology, Irrua Specialist Teaching Hospital, Irrua, Nigeria.
T. O. Otumu
Department of Medical Microbiology, Ambrose Alli University, Ekpoma, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Background: Lassa fever is a viral haemorrhagic illness endemic to Nigeria and other West African countries. Severe cases are often associated with abnormal coagulation and impaired platelet function.
Objective: This study primarily assessed coagulation parameters and examined their correlation with clinical outcomes in patients with acute Lassa fever.
Patients and Methods: This hospital-based case-control study included 324 participants: 108 Lassa virus-positive patients, 108 febrile Lassa-negative patients (Control 1), and 108 afebrile Lassa-negative individuals (Control 2). Prothrombin time (PT) and activated partial thromboplastin time (APTT) were measured using standard methods. Fibrinogen and D-dimer levels were determined via a sandwich enzyme-linked immunosorbent assay technique.
Results: Mean PT and APTT were significantly higher in the Lassa-positive group compared with both control groups (PT: p < 0.001; APTT: p = 0.048). Prolonged coagulation times were observed in 23 of 108 (21.3%) patients with Lassa fever (p < 0.001). Median fibrinogen levels (mg/dL) were lower in patients with Lassa fever [272.65 (interquartile range (IQR): 204.8–366.8)] than in Control 1 [335.55 (258.5–398.6)] and Control 2 [306.90 (245.6–355.2)], with statistically significant differences (p < 0.001). Median D-dimer levels (ng/mL) were elevated in patients with Lassa fever [1054.00 (593–1588)] compared with Control 1 [325.50 (173–715)] and Control 2 [188.00 (145–273)] (p < 0.001).
Conclusions: Lassa fever is associated with significant alterations in coagulation parameters. Patients with acute Lassa infection showed elevated PT, APTT, and D-dimer levels, along with decreased fibrinogen levels, compared with controls. These findings underscore the role of coagulopathy in the pathogenesis and severity of Lassa fever.
Keywords: Lassa fever, blood, coagulation, febrile, haemorrhagic, D-dimer