Prolonged Clotting Time Research Articles

Association between abnormal systemic coagulation inflammation index and recurrence of deep venous thrombosis as well as quality of life: A retrospective study.

Deep vein thrombosis (DVT) of the lower limb is a significant clinical challenge with the potential for recurrence, which can lead to increased morbidity and reduced quality of life. A retrospective case-control study was conducted involving 367 patients diagnosed with lower limb DVT from June 2020 to June 2023. Patients were categorized into a recurrence group (n = 121) and a non-recurrence group (n = 246) based on DVT occurrence. Data were systematically collected from medical records, including demographic information, thrombus characteristics, patient compliance, coagulation parameters, inflammatory markers, and quality of life assessments using the CIVIQ-20 and SF-36 scales. The recurrence group had significantly higher mean age, history of orthopedic diseases, and pregnancy, reduced compliance with compression therapy and anticoagulation, and elevated inflammatory markers including IL-6, IL-8, and TNF-α. Prolonged coagulation times (PT, APTT, TT) were associated with a lower risk of recurrence. The SCI index was significantly lower in the recurrence group. Multivariate logistic regression identified age, IL-6, IL-8, PT, APTT, TT, and SCI index as significant predictors of recurrence. Quality of life scores were lower in the recurrence group, indicating a higher impact on mental and overall health. ROC analyses demonstrated strong predictive capacity (AUC = 0.905) of SCI index. The study underscores the multifactorial nature of DVT recurrence, highlighting the role of age, systemic inflammation, coagulation times, and compliance with therapeutic interventions. The SCI index emerges as a compelling prognostic marker for assessing the risk of DVT recurrence. These findings emphasize the need for comprehensive management strategies incorporating these parameters to prevent recurrence and improve patients' quality of life.

Brodifacoum causes coagulopathy, hemorrhages, and mortality in rainbow trout (Oncorhynchus mykiss) at environmentally relevant hepatic residue concentrations.

Widely used second-generation anticoagulant rodenticides like brodifacoum are classified as persistent, bioaccumulative, and toxic. Widespread exposure of terrestrial and avian non-target species is well-known and recently hepatic anticoagulant rodenticide residues have been detected in wild fish. However, no sufficient data exist to interpret the effects of these findings on fish health. In order to assess the potential impact of rodenticide residues on fish, we exposed rainbow trout (Oncorhynchus mykiss) to brodifacoum-spiked feed. In a first experiment, individually kept trout (body weight ca. 200 g) were exposed to a single dose of brodifacoum and observed for 15 days. In a second experiment, fish (body weight ca. 330 g) were kept in groups and fed every 7 or 8 days with brodifacoum-spiked feed for up to 60 days. Sampling of trout every 15 days over the 60 days period allowed monitoring of brodifacoum concentrations in serum, liver, and muscle tissue, as well as occurring effects over the course of the experiment. In both experiments, brodifacoum doses of ≥ 75 µg/kg body weight caused prolonged or non-measurable blood coagulation times. Disturbed hemostasis led to hemorrhages and anemia with significantly decreased albumin levels. In the 60 days-experiment, brodifacoum doses ≥ 100 µg/kg body weight caused additionally discoloration, apathy, and anorexia, resulting in reduced weight gain, and ultimately mortality. The delay until the onset of overt symptoms (14-17 days) highlights the importance of test duration while investigating effects of anticoagulant rodenticides in fish. The lowest hepatic brodifacoum concentration associated with effects in trout was on average 122.6 ng/g liver wet weight, which is in the range of previously reported brodifacoum residues in wild fish. These findings illustrate the risks associated with the use of anticoagulant rodenticides for freshwater fish and reinforce the need to stipulate all available and appropriate risk mitigation measures to prevent emissions at source.

Carthamus tinctorius L. protects cerebral ischemia/reperfusion injury via arachidonic acid/p53-mediated apoptosis axis.

Stroke is a debilitating disease and the second leading cause of death worldwide, of which ischemic stroke is the dominant type. Carthamus tinctorius L., also known as safflower, has been used to treat cerebrovascular diseases, especially ischemic stroke in many Asian countries. However, the underlying mechanisms of safflower in preventing ischemic stroke remains elusive. This study aims to elucidate the potential of safflower as a drug candidate for the prevention of ischemic stroke and to delineate its protective effects and potential mechanisms in a rat model of cerebral ischemia-reperfusion injury (CI/RI). The aqueous extract of safflower (AESF) was verified using HPLC-UV, HPLC-MS, and TLC. The inhibitory effect of AESF on platelet aggregation was detected in vitro and in zebrafish and mice. A CI/RI model in rats was established by middle cerebral artery occlusion and reperfusion to study the protective effect of AESF on ischemic stroke. 2,3,5-triphenyltetrazolium chloride, hematoxylin and eosin, and Nissl's staining were employed to evaluate the pathological changes of brain tissue. In addition, metabolomics, ELISA, and Western blot were used to uncover the molecular alteration induced by AESF. AESF significantly inhibited platelet aggregation in vitro, reduced the thrombogenesis in zebrafish, and prolonged clotting time in mice. In addition, AESF alleviated neurological dysfunction, cerebral oedema, cerebral infarct size, cerebral histopathological damage induced by ischemia-reperfusion, improved neuronal survival, increased serum levels of SOD and CAT, and decreased levels of iNOS and NO. Metabolomics revealed that AESF attenuated the metabolic disturbances in brain caused by I/R injury via regulating 38 metabolites particularly related to the arachidonic acid (AA) metabolism. Moreover, AESF elevated the serum levels of 6-keto-PGF1α, a pivotal metabolite of AA, downregulated the protein expression of p53, Bax, cleaved caspase-9, cleaved caspase-3, and cleaved caspase-8, and upregulated that of Bcl-2. AESF mitigated CI/RI through preventing platelet aggregation, alleviating oxidative stress, and suppressing apoptosis partially via modulating AA metabolism/p53-mediated apoptosis axis.

Acute liver failure caused by paracetamol intoxication in a severely depressed patient with suicidal intent: A case report

BACKGROUND: Paracetamol poisoning has extensive implications, and one of the most dangerous is the involvement of liver dysfunction. Such cases are rare but require comprehensive evaluation and management. CASE: A 19-year-old female presented to the Emergency Department (ED) with nausea, vomiting, and epigastric pain after ingesting 20 grams of paracetamol with alcohol in a suicide attempt. Her history revealed severe depression with symptoms of anhedonia, anergy, and self-harming behavior. Laboratory results showed elevated liver enzymes and prolonged coagulation time, though other organ functions were normal. She was diagnosed with acute liver failure due to paracetamol intoxication and was treated with N-acetylcysteine (NAC), omeprazole, ondansetron, vitamin K, and psychiatric counseling. After seven days of hospitalization, her clinical condition improved, with plans for outpatient follow-up and prescribed medications. CONCLUSION: This case highlights the importance of addressing adolescent mental health and providing education on the dangers of drug overdose, along with access to psychological support to prevent self-harm.

Cure of Congenital Purpura Fulminans via Expression of Engineered Protein C Through Neonatal Genome Editing in Mice.

PC (protein C) is a plasma anticoagulant encoded by PROC; mutation in both PROC alleles results in neonatal purpura fulminans-a fatal systemic thrombotic disorder. In the present study, we aimed to develop a genome editing treatment to cure congenital PC deficiency. We generated an engineered APC (activated PC) to insert a furin-cleaving peptide sequence between light and heavy chains. The engineered PC was expressed in the liver of mice using an adeno-associated virus vector or CRISPR/Cas9 (clustered regularly interspaced short palindromic repeats/clustered regularly interspaced short palindromic repeat-associated 9)-mediated genome editing using an adeno-associated virus vector in vivo. The engineered PC could be released in its activated form and significantly prolonged the plasma coagulation time independent of the cofactor activity of PS (protein S) in vitro. The adeno-associated virus vector-mediated expression of the engineered PC, but not wild-type PC, prolonged coagulation time owing to the inhibition of activated coagulation FV (factor V) in a dose-dependent manner and abolished pathological thrombus formation in vivo in C57BL/6J mice. The insertion of EGFP (enhanced green fluorescent protein) sequence conjugated with self-cleaving peptide sequence at Alb locus via neonatal in vivo genome editing using adeno-associated virus vector resulted in the expression of EGFP in 7% of liver cells, mainly via homology-directed repair, in mice. Finally, we succeeded in improving the survival of PC-deficient mice by expressing the engineered PC via neonatal genome editing in vivo. These results suggest that the expression of engineered PC via neonatal genome editing is a potential cure for severe congenital PC deficiency.

The factor XI/XIa antibody abelacimab combined with enoxaparin inhibits filter clotting in hemodialysis circuits ex vivo

Drugs targeting factor XI may offer an alternative to heparin for preventing blood clotting in extracorporeal circulation. We investigated the effects of abelacimab, a novel monoclonal antibody targeting factor XI. We collected whole blood samples into two bags (each 240 ml, control group: enoxaparin 1.2 mg, treatment group: enoxaparin 1.2 mg plus abelacimab 5 mg) and circulated in a hemodialysis device for up to 3 h. We performed whole blood aggregation and thromboelastometry at several time points. Time to filter clotting was the primary endpoint. We included 10 volunteers. Each volunteer’s blood was split into two bags (containing enoxaparin +/- abelacimab) and used simultaneously on two hemodialysis devices. The treatment group’s time to filter clotting was significantly prolonged (treatment: 180 min, IQR 180–180 vs. control: 120 min, IQR 97–147, p < 0.001), and the transmembrane pressure was significantly lower at the end of the circuit flow (treatment: 13 mmHg vs. control: 65 mmHg, p = 0.001). Fibrinogen levels and median platelet counts were preserved. Platelet aggregation was better preserved in the treatment group for ristocetin (p = 0.015), thrombin receptor activating peptide (p = 0.015), and arachidonic acid (p = 0.001). Thromboelastometry showed prolonged clotting times in the treatment group at the end of the experiment (INTEM, p < 0.001; HEPTEM, p = 0.001). Abelacimab prolonged the time to filter clotting in this ex vivo model of hemodialysis. This is an aggressive model due to the frequent re-circulation of blood and a lack of endothelial cells. These data provide support for testing abelacimab in patients on hemodialysis.

Vesicular Carriers for Improved Oral Anticoagulation Competence of Rivaroxaban: In Vitro and In Vivo Investigation

Rivaroxaban is an anticoagulant for avoidance and therapy of thromboembolic disorders. Unfortunately, oral bioavailability of rivaroxaban is compromised with dose increments. Accordingly, the aim was to test nano-vesicular lipid systems for improved oral anticoagulation activity of rivaroxaban. Rivaroxaban loaded niosomes, bilosomes and spanlastic formulations were prepared. The prepared systems were assessed in terms of particle size, zeta potential, transition electron microscopic features (TEM), entrapment efficiency, in-vitro drug release, and in-vivo anticoagulation performance in rats. The prepared vesicular systems exposed spherical negatively charged vesicles with mean particle size values between 136.6 nm to 387.9 nm depending on the composition. Rivaroxaban was efficiently entrapped in the vesicular systems with entrapment efficiency values ranging from 92.4% to 94.0%. Rivaroxaban underwent sustained release from the fabricated vesicular systems. The in vivo performance of the tested preparation revealed significant enhancement of the anticoagulation parameters. This was manifested from the prolonged clotting time, and prothrombin time. Moreover, the cut tails of the examined rats receiving the formulated nano-systems exposed a lengthy tail bleeding time compared to those receiving the un-processed rivaroxaban aqueous dispersion. In Conclusion, niosomes, bilosomes and spanlastic nano-dispersions have a potential to overwhelm the oral anticoagulation efficiency of rivaroxaban with spanlastic ranked as best.Graphical

The quality and technological parameters of milk obtained from dairy cows with subclinical mastitis

Mastitis is one of the most common diseases in dairy cattle. It significantly reduces milk quality and yield, thus incurring economic losses for farmers. This study investigates the impact of various bacterial pathogens on the somatic cell count, milk composition, and technological properties of milk samples from 302 clinically healthy Polish Holstein-Friesian cows kept under intensive rearing conditions. Of the 462 milk samples analyzed, 85.06% were contaminated with bacteria. The majority were coagulase-negative staphylococci (52.60%).-Escherichia coli, Streptococcus dysgalactiae, Streptococcus uberis, or Staphylococcus aureus, or Streptococcus agalactiae, a major pathogen, were identified in 16.66% of samples; their presence was associated with higher SCC levels. Additionally, contamination with S. aureus or S. agalactiae had prolonged clotting time, adversely affected curd and whey quality, with curd yield remaining unaltered. Bacterial contamination did not appear to significantly impact the yield of milk or its main components, viz. protein, casein, lactose, fat, total solids, solid nonfat, free fatty acid or citric acid. Although pH, freezing point depression (FDP), and acidity also remained unaffected by bacterial contamination, they were significantly influenced by herd-year-season of calving and herd-year-time of sampling interaction effects. The results indicate that the presence of bacteria causing subclinical mastitis negatively influences milk processing potential. However, fixed linear regression indicated that the number of colony-forming units (cfu/ml) only had a significant influence on FPD and clotting time, and as such, the number of bacteria in a sample did not influence milk yield or quality during subclinical chronic mastitis.

Association between Abnormal Systemic Coagulation Inflammation Index and Recurrence of Deep Venous Thrombosis as well as Quality of Life: A Retrospective Study.

BackgroundDeep vein thrombosis (DVT) of the lower limb is a significant clinical challenge with the potential for recurrence, which can lead to increased morbidity and reduced quality of life. This study aimed to identify factors associated with the recurrence of lower limb DVT by analyzing clinical, demographic, and biological markers, including the systemic coagulation-inflammation (SCI) index. MethodsA retrospective case-control study was conducted involving 367 patients diagnosed with lower limb DVT from June 2020 to June 2023. Patients were categorized into a recurrence group (n = 121) and a non-recurrence group (n = 246) based on DVT occurrence. Data were systematically collected from medical records, including demographic information, thrombus characteristics, patient compliance, coagulation parameters, inflammatory markers, and quality of life assessments using the CIVIQ-20 and SF-36 scales. Statistical analyses included differential analysis, correlation analyses, logistic regression, and receiver operating characteristic (ROC) analyses to identify predictive factors for DVT recurrence. ResultsThe recurrence group had significantly higher mean age, history of orthopedic diseases, and pregnancy, reduced compliance with compression therapy and anticoagulation, and elevated inflammatory markers including IL-6, IL-8, and TNF-α. Prolonged coagulation times (PT, APTT, TT) were associated with a lower risk of recurrence. The SCI index was significantly lower in the recurrence group. Multivariate logistic regression identified age, IL-6, IL-8, PT, APTT, TT, and SCI index as significant predictors of recurrence. Quality of life scores were lower in the recurrence group, indicating a higher impact on mental and overall health. ROC analyses demonstrated strong predictive capacity (AUC = 0.905) of SCI index. ConclusionThe study underscores the multifactorial nature of DVT recurrence, highlighting the role of age, systemic inflammation, coagulation times, and compliance with therapeutic interventions. The SCI index emerges as a compelling prognostic marker for assessing the risk of DVT recurrence. These findings emphasize the need for comprehensive management strategies incorporating these parameters to prevent recurrence and improve patients' quality of life.

Effects of Variable Doses of Neurokinin B on Hematological and Coagulation Parameters in Adult Male Rats

Objective: To evaluate the dose-dependent effects of Neurokinin B on hematological and coagulation parameters in adult male Sprague Dawley rats. Study Design: Laboratory-based experimental study Place and Duration of Study: Gomal University and KMU Institute of Medical Sciences from February 2019 to April 2021. Methodology: Adult male Sprague Dawley rats (n=5 per group) were administered intraperitoneally with Neurokinin B at doses of 1 µg, 1 ηg and 1 ρg for 12 days consecutively. Control rats received distilled water injections. After 12 days, rats were sacrificed, and blood samples were collected from the left ventricle for hematological and coagulation analysis. Results: Bleeding time was significantly prolonged in NKB-µg (114±17.10sec) and Neurokinin B -ηg (72±22.25sec) compared to control (33±12.55sec). Clotting time (CT) was also increased (NKB-µg: 111±17.10sec; NKB-ηg: 69±17.10sec, control: 42±12.55sec), as did prothrombin time (PT) [NKB-µg: 93.60±10.92sec; NKB-ηg: 63.40±12.66sec, control: 15±4.12sec] and activated partial thromboplastin time (APTT) [NKB-µg: 94.80±14.04sec; NKB-ηg:68.60±13.74sec, control: 19.40±2.97sec]. Additionally, mean platelet volume [NKB-µg:8.94±0.36fl, control: 8.04±0.48fl] and leukocyte count (×103/µl) [NKB-µg: 12.14±0.69, control: 8.87±1.32] were significantly increased in NKB-treated animals compared to control. There was a significant increase in international normalized ratio in NKB-µg (6.86±0.80) and NKB-ηg (4.65±0.93) compared to control group (1.10±0.30). Conversely, platelet count (×103/µl) was decreased significantly in NKB-µg group (787.80±48.51) compared to the control group (960.60±58.71). Conclusion: NKB administration led to leukocytosis, thromboctopenia, and affected coagulation pathways with prolonged BT, CT, PT, APTT and INR dose-dependently.

Epidemiological Aspects, Clinicopathology, Hemato-biochemistry and Therapeutic Management of Viperine Snake Envenomation in Buffaloes (Bubalus bubalis)

Background: Poisonous snakebite is a neglected tropical disease, frequently reported in animals including buffaloes. Snakebites are responsible for considerable morbidity and mortality in animals causing economic losses to dairy farmers. Methods: To establish the baseline data of epidemiology, clinical syndrome, hemato-biochemistry and diagnosis of viper snakebites and to standardize the treatment of viper snakebite in buffaloes. Result: The highest incidence of viper envenomation was observed during the monsoon and post-monsoon season in female buffaloes above 4 years of age. The clinical signs such as tachycardia, increased respiration rate, ascending swelling of affected limbs, asymmetrical swelling with dyspnea in case of bite over face and bleeding at the site of bite were observed in envenomed buffaloes. Hemato-biochemical analysis revealed neutrophilic leukocytosis, thrombocytopenia, prolonged capillary blood clotting time, elevated values of blood urea nitrogen (BUN) and creatinine. Post-mortem examination showed hemorrhages and blood-stained serous fluid in subcutaneous tissue and skeletal muscles of the affected limbs. The histopathological changes such as extensive myonecrosis and hemorrhages with marked edema in skeletal muscles, widespread interstitial and intra-alveolar hemorrhages and fibrinous microthrombi in pulmonary vasculature, multifocal to coalescing areas of massive hemorrhages and coagulative necrosis within hepatic parenchyma and marked degeneration of renal tubular epithelium were evident. Therapeutic regimen consisting of polyvalent anti-snake venom, with antibiotics, diuretics, vitamin B complex, styptics, fluids and corticosteroids in non-pregnant while non-steroidal anti-inflammatory drugs in pregnant buffaloes was used. The present treatment strategy showed subsidence of clinical signs, restoration of platelet count, blood clotting time, urea nitrogen and creatinine values depicting clinical recovery with 88.15% survival rate in treated buffaloes.

Enhanced photodynamic therapy of curcumin using biodegradable PLGA coated mesoporous silica nanoparticles

Since the available treatments are not highly effective to combat cancer, therefore, the alternative strategies are unavoidable. Photodynamic therapy (PDT) is one of the emerging approaches which is target specific and minimally invasive. This study explores the successful development of Poly (D,L-lactide-co-glycolide) (PLGA) coated mesoporous silica nanoparticles (MSNs) and their augmented effects achieved by integrating curcumin (Cur) and cetyltrimethylammonium bromide (CTAB) in the polymeric layer and silica’s pores, respectively. The synthesized nanocarriers (Cur-PLGA-cMSNs) have shown preferential targeting to the cellular organelles facilitated by CTAB’s and Cur’s affinity to mitochondria. CTAB and Cur-based PDT induced oxidative stress and generation of reactive oxygen species (ROS), resulting in dysfunctional mitochondria and triggered apoptotic pathways. PLGA coating has produced multifunctional effects, including; gatekeeping effects at pore openings, providing an extra loading site, enhancing the hemocompatibility of MSNs, and masking the free cur-related prolonged coagulation time. Cur-PLGA-cMSNs, as a multifaceted and combative approach with synergistic effects demonstrate promising potential to enhance outcomes in cancer treatment.

Antiphospholipid syndrome autoantibodies induction after treatment with anti-TNF alpha therapy in patients with IBD

IntroductionAnt-iTNF treatment has been broadly linked with autoantibodies and autoimmune disorders development. After the clinical observation of aPTT (activated partial thromboplastin clotting time) prolongation in our cohort of IBD patients treated with anti-TNF, we sought to determine the presence of antiphospolipid antibodies in our population, along with antiphospholipid syndrome (APS) occurrence. MethodsWe included in the study 289 patients treated with anti-TNFα antibodies. ResultsTwenty four of 289 patients presented a prolonged aPPT (8.3%) after starting anti-TNF treatment. We found antiphospholipid antibodies in 70.8% (17/24) of patients with aPTT prolongation. No major thrombotic events were reported although one patient met criteria for APS because of persistent antiphospolipid antibodies and two miscarriages. Another patient was diagnosed with lupus-like syndrome. ConclusionAnti-TNF treatment is associated with the induction of various antibodies, among them, antiphospholipid antibodies. However, a very low number of patients develop APS. Testing for antiphospholipid antibodies patients with prolonged aPPT could identify those at risk and lead to individualized treatment. Additional prospective studies are necessary to acquire more information.

Construction of a gradient cobblestone pattern on pyrolytic carbon surface for improved anti-thrombus

Surface modification is believed to be one of the most effective solutions to prevent thrombus formation associated with mechanical heart valves. Herein, we report, for the first time, the fabrication of a gradient cobblestone pattern on the pyrolytic carbon (PyC) surface aiming to improve its anti-thrombotic properties. A unique cobblestone pattern with gradient changing interspacing was generated on the PyC surface through laser etching. After coating with fluorosilane, the surface exhibited a water contact angle gradient ranging from 110 to 173°. The morphological and physicochemical properties, mechanical durability, drag reduction, in vitro anti-thrombotic properties, and in vivo biocompatibility of the surface were investigated to evaluate its potential as a heart valve replacement. It was found that the hydrophobic gradient wettability surface exhibited an excellent self-driving effect and mechanical durability, significantly reduced hemolysis rate and platelet adhesion, and prolonged coagulation time compared to the counterpart without gradient wettability. Furthermore, the gradient wettability surface demonstrated excellent in vivo biocompatibility. These findings are important for the design of artificial heart valves with improved anti-thrombotic performance.

Stečena koagulopatija u trogodišnjegdječaka s makrohematurijom– prikaz bolesnika

Acquired coagulopathy is a rare, potentially life-threatening disorder which should be suspected if acute bleeding in patients with a negative previous hemorrhagic diathesis is encountered. This disease arises due to the formation of antibodies against clotting factors in a previously healthy child or adult, which specifically partially or completely neutralize the procoagulant activity of clotting factors or accelerate their removal from the circulating blood, reducing their plasma concentrations and increasing the bleeding tendency. The aforementioned disorder should be confirmed by determining global coagulation times, concentrations of individual clotting factors, and determining the presence of specific or non-specific antibodies. Timely treatment aimed at prompt stopping of bleeding and eradicating the resulting inhibitors will prevent the unfavorable outcome. It is recommended to continue monitoring patients in the outpatient setting with determination of PT and APTT for a year, because in 20% of cases a relapse of the disease occurs, although more often in adults. In this paper, we presented a three-year-old boy in whom we determined prolonged global coagulation times and the presence of non-specific inhibitors of the coagulation factors F II, F IX, F XI and F XII through the diagnostic workup of macrohematuria. The treatment with fresh frozen plasma and corticosteroids resulted in clinical improvement and disease remission. Acquired coagulopathy is a very rare disorder in childhood with scarce literature data. The aim of this paper is to demonstrate the possible causes, clinical course and treatment of this life-threatening disorder in children.

#2781 Renal cortical necrosis—a rare cause of acute kidney injury

Abstract Background and Aims Renal cortical necrosis (RCN) is a rare and catastrophic cause of acute kidney injury (AKI). It is characterized by ischemic destruction of all the elements of renal cortex due to marked reduction in renal arterial perfusion of renal cortex due to vascular spasm and microvascular injury. It can be patchy or diffuse depending upon the cause and extent of hypoperfusion. Snake bite is rare cause of RCN. Incidence of RCN following snake bite has been reported to be as high as in 25% of the bitten patients to &amp;lt;1%. Lack or delay in receiving anti snake venom (ASV) has been observed to be a contributing factor in development of RCN following snake bite. Method A 45-year-old female had an unknown bite on foot while returning to home at twilight. She had intense pain at site of bite with slight ooze of blood. Overnight she had vomiting and pain abdomen. Subsequently she developed progressive fall in urine output and dyspnoea. After about 36 hours of bite at the time of admission in hospital she had anuria, prolonged whole blood clotting time, tachypnoea, hypoxemia and required oxygen (O2) to maintain normal O2 saturation. She was given two doses of polyvalent ASV 6 hours apart which corrected her coagulation defect. Investigations showed: haemoglobin—9 gm/dl, total leucocyte count—18700/mcl, platelet—1.15 lakh/mcl, blood urea—88 mg/dl and serum creatinine—10.5 mg/dl. She was managed with haemodialysis and supportive care. Even after 3 weeks of onset of AKI, she had anuria so a kidney biopsy was done. Results kidney biopsy on light microscopy examination showed 9 glomeruli; 8 revealing global tuft necrosis along with necrosis of adjacent tubules and vasculature and necrotic process affected around 60% of sampled cortical area consistent with cortical necrosis (Fig. 1). She was continued with haemodialysis support and urine output and pre-dialysis serum creatinine were monitored. Her urine output after 3 months of onset of AKI is around one litre per day but her pre-dialysis serum creatinine stays in the range of 9-10 mg/dl and so she continues to receive biweekly haemodialysis. Conclusion In our index case, there was delay in getting ASV which may have contributed to development of RCN. So, early treatment of snake bite is important to prevent this catastrophic complication.

ANTICOAGULANT PROPERTIES OF RECOMBINANT ANNEXIN А5

Aim: Because of its involvement in membrane properties, annexin A5 has a significant impact on membrane-dependent processes within hemostasis, including the initiation of the coagulation cascade, the activation of factor X and prothrombin, and the function of protein C on membrane surfaces. By binding to phosphatidylserine, annexin A5 acts as a protective shield, masking exposed phospholipid surfaces and exerting a general anticoagulant effect. Considering the significant influence of annexin A5 on the activation of hemostatic compounds on cell surfaces, it is crucial to further investigate its mechanisms. Methods: After purification of polyHis-Tag proteins by immobilized metal affinity chromatography from E. coli Rosetta cell biomass, we checked the purity of the eluate by SDS-PAGE. We performed APTT test, PT test and platelet aggregation to find out the anticoagulation influence of recombinant annexin A5 in these tests. Results: Annexin in the highest concentration of 40 μg/ml prolonged blood plasma clotting time in activated partial thrombin time by almost 50%, blood plasma clotting time in prothrombin time by almost 15% and did not influence the rate of platelet aggregation. Conclusion: It can be assumed that its anticoagulant effect is directed to the enzyme complexes of the hemostasis system and does not extend to platelet receptors. The obtained protein can be used to study the activation of hemostatic components on cell surfaces.

A Study on Blood Group Distribution, Bleeding Time, and Clotting Time Variation among First-year Undergraduate Medical Students

Abstract Background: ABO blood group status of an individual is an important test that helps in blood grouping, cross-matching, solving medicolegal aspects, etc. Furthermore, bleeding time (BT) and clotting time (CT) are important tests to plan surgery, check response to anticoagulants, etc. BT is affected by platelet function while CT is affected by clotting factors. BT is prolonged in congenital or acquired platelet abnormalities. Defect or absence of one or more factors can cause prolonged CT. Aims and Objectives: To determine the blood group, of the students and to determine their BT and CT. Materials and Methods: Institution-based cross-sectional observational study done in the Department of Physiology, Tripura Medical College and Dr. BRAM Teaching Hospital. BT and CT were done by Duke’s Method and Capillary glass tube method respectively. Blood groups were determined based on the presence or absence of agglutination. Qualitative data were expressed in percentage and quantitative data in frequency, mean, and standard deviations. Results: Sixty-one (58%) females and 44 (42%) males participated. Blood group O and blood groups B (33.3%) were equally most predominant. BT is &gt;4 min (total) in 13% of students (n = 14) with slightly more in males (16% males). In addition, CT is &gt;6 min in 37% of students (n = 39) with slightly more in females (39% females). Conclusion: In our study, blood group O and blood group B were equally the most predominant. CT toward upper normal ranges (&gt;6 min) slightly more in females than males.

Hypocoagulability in severe yellow fever infection is associated with bleeding: results from a cohort study

BackgroundSevere yellow fever infection (YFI) may be complicated by a hemorrhagic diathesis. However, the hemostasis profile of YFI has rarely been reported. ObjectivesThe aim of this study was to characterize the hemostatic features of YFI by using a rotational thromboelastometry (ROTEM). MethodsWe evaluated clinical, laboratory, and ROTEM parameters in adults with severe YFI and their correlation with hemostatic variables according to bleeding and death. ResultsA total of 35 patients were included (median age, 49 years). ROTEM was performed in 22 patients, of whom 21 (96%) presented bleeding and 4 (18%) died. All patients who died had major bleeding. Patients who died presented prolonged clotting time (CT; median, 2326 seconds; IQR, 1898-2986 seconds) and reduced alpha angle (median, 12°; IQR, 12°-15°) in comparison with patients who had minor (median CT, 644 seconds; IQR, 552-845 seconds and alpha angle, 47°; IQR, 28°-65°) and major (median CT, 719 seconds; IQR, 368-1114 seconds and alpha angle, 43°; IQR, 32°-64°) bleeding who survived. In patients who had bleeding, CT showed a strong negative correlation with factor (F)V (r = −.68), FIX (r = −.84), and FX (r = −.63) as well as alpha angle showed a strong negative correlation with FIX (r = −.92). In patients who died, the correlations were even stronger. A total of 19/21 (90%) patients presented hypocoagulability assessed by ROTEM. ConclusionHypocoagulabitity is the hallmark of the bleeding diathesis of severe YFI. Abnormal CT and alpha angle associated with death and could be used as potential predictors of adverse outcome in severe YFI.

Dextran sulfate bulk and surface-modified microfiltration membrane for simultaneous blood plasma harvesting and low-density lipoprotein removal during plasmapheresis

Plasmapheresis is currently used for the harvesting of blood plasma in medical labs and plasma donation centers. This is a fast, single-step membrane process for both collection of blood plasma and simultaneous blood cell isolation. This paper presents the development of a novel membrane that can be used to simultaneously harvest blood plasma and isolate low-density lipoprotein (LDL), known as bad cholesterol, from the blood. To achieve this goal, dual surface and bulk modification by dextran sulfate (DS) was performed on a polyethersulfone (PES) membrane containing single wall carbon nanotubes (SWCNT). DS is an anionic ligand that repels negatively charged substances like red blood cells (RBCs) and adsorbs positively charged substances like Apo B100; the apoprotein of LDL. Scanning Electron Microscope (SEM), Energy Dispersive X-Ray (EDX), and Fourier Transform Infrared (FTIR) spectroscopy analyses provided evidence of the grafting of DS on single wall carbon nanotubes (DS-SWCNT). Surface studies including water contact angle, zeta potential analysis, surface morphology, Attenuated Total Reflectance-FTIR (ATR-FTIR), and EDX, confirmed the presence of DS on the PES membrane surface. The SEM cross-section results showed the formation of a two-zone morphology with an open structure on the upside and a dense structure on the downside that provide optimal conditions for efficient separation of blood cells. The complete blood count (CBC) and biochemistry analyses revealed dual bulk and surface-modified membrane, and a specific sample (DM2) showed the best performance for blood cells and LDL separation. The maximum separation of blood cells was 87% RBC, 98% white blood cells (WBCs), and 83% platelets (PLTs). Moreover, DM2 exhibited a sieving ratio for LDL of 0.33. Blood compatibility analyses confirmed that DM2 and other related samples had low hemolysis and prolonged coagulation times.