Increased Thrombopoiesis and Platelet Activation in Hantavirus-Infected Patients

Background. Thrombocytopenia is a common finding during viral hemorrhagic fever, which includes hemorrhagic fever with renal syndrome (HFRS). The 2 main causes for thrombocytopenia are impaired thrombopoiesis and/or increased peripheral destruction of platelets. In addition, there is an increased in...

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Bibliographic Details
Published in:The Journal of infectious diseases 2015-10, Vol.212 (7), p.1061-1069
Main Authors: Connolly-Andersen, Anne-Marie, Sundberg, Erik, Ahlm, Clas, Hultdin, Johan, Baudin, Maria, Larsson, Johanna, Dunne, Eimear, Kenny, Dermot, Lindahl, Tomas L., Ramström, Sofia, Nilsson, Sofie
Format: Article
Language:English
Subjects:
Adult
Blood Coagulation
Blood Platelets - physiology
Disseminated intravascular coagulation
Disseminated Intravascular Coagulation - blood
Disseminated Intravascular Coagulation - physiopathology
Female
Fibrinogen - analysis
hantavirus
Hantavirus - physiology
hemorrhagic fever with renal syndrome
Hemorrhagic Fever with Renal Syndrome - blood
Hemorrhagic Fever with Renal Syndrome - physiopathology
Humans
Kinetics
Male
Middle Aged
P-Selectin - blood
Platelet Activation
Platelet Count
platelets
Thrombocytopenia - blood
Thrombocytopenia - physiopathology
Thrombopoiesis
Thrombopoietin - blood
thrombosis
viral hemorrhagic fever
VIRUSES
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Summary:Background. Thrombocytopenia is a common finding during viral hemorrhagic fever, which includes hemorrhagic fever with renal syndrome (HFRS). The 2 main causes for thrombocytopenia are impaired thrombopoiesis and/or increased peripheral destruction of platelets. In addition, there is an increased intravascular coagulation risk during HFRS, which could be due to platelet activation. Methods. Thrombopoiesis was determined by quantification of platelet counts, thrombopoietin, immature platelet fraction, and mean platelet volume during HFRS. The in vivo platelet activation was determined by quantification of soluble P-selectin (sP-selectin) and glycoprotein VI (sGPVI). The function of circulating platelets was determined by ex vivo stimulation followed by flow cytometry analysis of platelet surface-bound fibrinogen and Pselectin exposure. Intravascular coagulation during disease was determined by scoring for disseminated intravascular coagulation (DIC) and recording thromboembolic complications. Results. The levels of thrombopoietin, immature platelet fraction, and mean platelet volume all indicate increased thrombopoiesis during HFRS. Circulating platelets had reduced ex vivo function during disease compared to follow-up. Most interestingly, we observed significantly increased in vivo platelet activation in HFRS patients with intravascular coagulation (DIC and thromboembolic complications) as shown by sP-selectin and sGPVI levels. Conclusions. HFRS patients have increased thrombopoiesis and platelet activation, which contributes to intravascular coagulation.
ISSN:0022-1899
1537-6613
1537-6613
DOI:10.1093/infdis/jiv161