Effect of Pulmonary Tuberculosis on Protein C, S, and Antithrombin-III among Therapy-naïve Ghanaian Adults; A Comparative Cross-Sectional Study

Background: Tuberculosis (TB) constitutes a global emergency as it affects one-third of the world’s inhabitants. Although pulmonary Tuberculosis (PTB) is curable, immunological responses to the infection induce several haematological derangements. This study evaluated the effect of PTB on Protein C, Protein S, Antithrombin-III, and blood count parameters. Methods. Ninety adults with ages ≥18 years were purposively recruited: 60 PTB patients and 30 non-TB controls. All patients were diagnosed with sputum GeneXpert MTB/Rif assay. Blood specimens were collected from each participant for Protein C, S, Antithrombin-III and complete blood count. Results: Pulmonary TB was associated with signifi cantly reduced Protein C activity (101.46 [87.61-128.3] vs 121.44 [99.50-149.8] IU/L, p=0.038), RBC (3.88±0.91 vs 4.80±0.55, p<0.0001), HgB (10.24±2.42 vs 11.78±1.42, p=0.0019), HCT (32.21±7.79 vs 42.05±4.97, p<0.0001), MCV (83.80 [79.33-90.08] vs 89.00 [83.75-92.00], p=0.0133) and PDW (12.95 [10.73-15.00] vs 15.30 [14.18-15.93], p<0.0001) compared to controls. Conversely, PTB patients were associated with signifi cantly increased MCH (26.83±4.33 vs 24.59±1.99, p=0.0086), TWBC (7.76 [6.06-9.78] vs 6.50 [4.85-7.50], p=0.0047), Abs. GRAN (5.27 [3.30-6.71] vs 3.75 [2.48-4.75], p=0.0226), RDW-CV (13.70 [13.20-15.43] vs 12.95 [12.50-13.65], p<0.0001), MCHC (32.10 [28.70-35.63] vs 27.85 [27.40-28.53], p<0.0001) and MPV (8.3 [6.7-9.7] vs 7.0 [6.4-7.5], p=0.0027) compared to controls. The PTB patients were disproportionately affected with anaemia (91.7%, p=0.001), erythrocytopenia (75.0%; p≤0.001) and reduced HCT (80.0%, p≤0.001). The frequency of thrombocytosis, leucocytosis, and granulocytosis (50.0%, p=0.013; 23.3%, p=0.013; 18.3%, p=0.025; respectively) in PTB patients were signifi cantly higher than in controls. Conclusion. Our findings suggest that PTB predisposes patients to hypercoagulability, with a significant reduction in Protein C activity but not Protein S and antithrombin-III. The condition causes derangements in erythrocytes, leucocytes, and thrombocytes, and disproportionately causes anaemia. Protein C activity and complete blood count are useful in the management of PTB and should be included in the routine workup for patients.

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This is an article published in Journal of Immunoassay and Immunochemistry on December 30th, 2020. https://doi.org/10.1080/15321819.2021.2001002

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Journal of Immunoassay and Immunochemistry on December 30th, 2020; https://doi.org/10.1080/15321819.2021.2001002

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https://doi.org/10.1080/15321819.2021.2001002
https://ir.knust.edu.gh/handle/123456789/15500

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