Haemostatic Changes in Five Patients Infected with Ebola Virus

Abstract

Knowledge on haemostatic changes in humans infected with Ebola virus is limited due to safety concerns and access to patient samples. Ethical approval was obtained to collect plasma samples from patients in Sierra Leone infected with Ebola virus over time and samples were analysed for clotting time, fibrinogen, and D-dimer levels. Plasma from healthy volunteers was also collected by two methods to determine effect of centrifugation on test results as blood collected in Sierra Leone was not centrifuged. Collecting plasma without centrifugation only affected D-dimer values. Patients with Ebola virus disease had higher PT and APTT and D-dimer values than healthy humans with plasma collected in the same manner. Fibrinogen levels in patients with Ebola virus disease were normal or lower than values measured in healthy people. Clotting times and D-dimer levels were elevated during infection with Ebola virus but return to normal over time in patients that survived and therefore could be considered prognostic. Informative data can be obtained from plasma collected without centrifugation which could improve patient monitoring in hazardous environments.

COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-Up

“…Nevertheless, it is yet unknown whether these hemostatic changes are a specific effect of SARS-CoV-2 or are a consequence of cytokine storm that precipitates the onset of systemic inflammatory response syndrome (SIRS), as observed in other viral disease (30)(31)(32)(33). Another consideration which has not yet been investigated is that the hemostatic changes seen with COVID-19 infection are related to liver dysfunction (34).…”

Extrapulmonary manifestations of COVID-19

“…The increased expression of ACE2 in endothelial cells after infection with SARS-CoV-2 may perpetuate a vicious cycle of endothelialitis that promotes thromboinflammation 29 . Collectively, hemostatic and inflammatory changes, which reflect endothelial damage and activation as well as critical illness, constitute a prothrombotic milieu, at least similar to and possibly more severe than that of other viral illnesses 86,95,96 .…”

COVID-19 Related Coagulopathy: A Distinct Entity?

“…According to this paradigm, the host response to COVID-19 is first localized in the lung parenchyma, but a systemic surge in pro-inflammatory cytokines can occur. Defined as a "cytokine storm," the incidence, role, and specific involvement of cytokine storms is yet to be addressed in SARS-CoV-2, and its interactions with hemostatic changes as observed in previous viral diseases [65][66][67] remain to be established.…”