scholarly journals Comparison of pathological clotting using haematological, functional and morphological investigations in HIV-infected and HIV-uninfected patients with deep vein thrombosis

2020 ◽  
Author(s):  
Brandon S Jackson ◽  
Julien Nunes Goncalves ◽  
Etheresia Pretorius
Keyword(s):  
Electron Microscopy ◽  
Deep Vein Thrombosis ◽  
Inflammatory Markers ◽  
Ultrastructural Changes ◽  
Hiv Positive ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
Inflammatory Changes ◽  
Scanning Electron ◽  
Hiv Negative

Abstract Background Patients infected with the human immunodeficiency virus (HIV) are more prone to systemic inflammation and pathological clotting, and many may develop deep vein thrombosis (DVT) as a result of this dysregulated inflammatory profile. Coagulation tests are not routinely performed unless there is a specific reason. Methods We recruited ten healthy control subjects, 35 HIV negative patients with deep vein thrombosis (HIV negative-DVT), and 13 HIV patients with DVT (HIV positive-DVT) on the primary antiretroviral therapy (ARV) regimen- Emtricitabine, Tenofovir and Efavirenz. Serum inflammatory markers, haematological results, viscoelastic properties (using thromboelastography-TEG) and scanning electron microscopy (SEM) of whole blood (WB) were used to compare the groups. Results DVT patients (HIV positive and HIV negative) have raised inflammatory markers. The HIV positive-DVT group has anaemia in keeping with anaemia of chronic disorders. DVT patients have a hypercoagulable profile on the TEG but no significant difference between HIV negative-DVT and HIV positive-DVT groups. The TEG analysis compared well and supported our ultrastructural results. Scanning electron microscopy of DVT patient’s red blood cells (RBCs) and platelets demonstrates inflammatory changes including abnormal cell shapes, irregular membranes and microparticle formation. All the ultrastructural changes were more prominent in the HIV positive-DVT patients. Conclusions It is well-known that HIV infection is linked to inflammation and inflammation is linked with the presence of a hypercoagulable state. The presence of DVT is also associated with inflammation. Whether HIV is the cause of the DVT is not certain. Although there were trends that HIV infected patients were more hypercoagulable on functional tests (viscoelastic profile) compared to HIV uninfected patients, there were no significant differences between the 2 groups. Morphologically there were inflammatory changes in patients with DVT. These ultrastructural changes, specifically with regard to platelets, appear more pronounced in HIV infected patients which may contribute to increased risk for hypercoagulability and deep vein thrombosis.

scholarly journals Comparison of pathological clotting using haematological, functional and morphological investigations in HIV-positive and HIV-negative patients with deep vein thrombosis

2020 ◽  
Author(s):  
Brandon S Jackson ◽  
Julien Nunes Goncalves ◽  
Etheresia Pretorius
Keyword(s):  
Electron Microscopy ◽  
Deep Vein Thrombosis ◽  
Inflammatory Markers ◽  
Ultrastructural Changes ◽  
Hiv Positive ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
Inflammatory Changes ◽  
Scanning Electron ◽  
Hiv Negative

Abstract Background Patients infected with the human immunodeficiency virus (HIV) are more prone to systemic inflammation and pathological clotting, and many may develop deep vein thrombosis (DVT) as a result of this dysregulated inflammatory profile. Coagulation tests are not routinely performed unless there is a specific reason. Methods We recruited ten healthy control subjects, 35 HIV negative patients with deep vein thrombosis (HIV negative-DVT), and 13 HIV patients with DVT (HIV positive-DVT) on the primary antiretroviral therapy (ARV) regimen- emtricitabine, tenofovir and efavirenz. Serum inflammatory markers, haematological results, viscoelastic properties using thromboelastography (TEG) and scanning electron microscopy (SEM) of whole blood (WB) were used to compare the groups. Results The DVT patients (HIV positive and HIV negative) have raised inflammatory markers. The HIV positive-DVT group has anaemia in keeping with anaemia of chronic disorders. DVT patients have a hypercoagulable profile on the TEG but no significant difference between HIV negative-DVT and HIV positive-DVT groups. The TEG analysis compared well and supported our ultrastructural results. Scanning electron microscopy of DVT patient’s red blood cells (RBCs) and platelets demonstrates inflammatory changes including abnormal cell shapes, irregular membranes and microparticle formation. All the ultrastructural changes were more prominent in the HIV positive-DVT patients. Conclusions Although there were trends that HIV-positive patients were more hypercoagulable on functional tests (viscoelastic profile) compared to HIV-negative patients, there were no significant differences between the 2 groups. The sample size was, however, small in number. Morphologically there were inflammatory changes in patients with DVT. These ultrastructural changes, specifically with regard to platelets, appear more pronounced in HIV-positive patients which may contribute to increased risk for hypercoagulability and deep vein thrombosis.

scholarly journals Haematological parameters and pathological clotting in deep vein thrombosis and patients with HIV

2019 ◽  
Author(s):  
Brandon S Jackson ◽  
Julien Nunes ◽  
Etheresia Pretorius
Keyword(s):  
Electron Microscopy ◽  
Scanning Electron Microscopy ◽  
Deep Vein Thrombosis ◽  
Inflammatory Markers ◽  
Hiv Positive ◽  
Vein Thrombosis ◽  
Coagulation Tests ◽  
Deep Vein ◽  
Scanning Electron ◽  
Hiv Negative

Abstract Background. Patients infected with the human immunodeficiency virus (HIV) are more prone to systemic inflammation and pathological clotting, and many may develop deep vein thrombosis (DVT) as a result of this dysregulated inflammatory profile. Coagulation tests are not routinely performed unless there is a specific reason. Methods. We recruited ten healthy control subjects, 35 HIV negative patients with deep vein thrombosis (HIV negative-DVT), and 13 HIV patients with DVT (HIV positive-DVT) on the primary antiretroviral therapy (ARV) regimen- Emtricitabine, Tenofovir and Efavirenz. Serum inflammatory markers, haematological results, viscoelastic properties (using thromboelastography-TEG) and scanning electron microscopy (SEM) of whole blood (WB) were used to compare the groups.Results. DVT patients (HIV positive and HIV negative) have anaemia with raised inflammatory markers which are more pronounced in HIV positive patients. HIV positive-DVT patients also have a microcytic hypochromic anaemia. DVT patients have a hypercoagulable profile on the TEG but no significant difference between HIV negative-DVT and HIV positive-DVT groups. The TEG analysis compared well and supported our ultrastructural results. Scanning electron microscopy of HIV positive-DVT patient’s red blood cells (RBCs) and platelets demonstrates inflammatory changes including abnormal cell shapes, irregular membranes and microparticle formation. All the ultrastructural changes were more prominent in the HIV positive-DVT patients. Conclusions. HIV positive patients have an increased hypercoagulability and DVT prevalence. Our results point to the importance of looking at the coagulation system function in HIV infected individuals with DVT. Parameters like haematological markers, coagulation tests (activated partial thromboplastin time and prothrombin time / International normalized ratio), thromboelastography and global clotting tests should be used as standard indicators of hypercoagulation and part of standard clinical practice.

scholarly journals Prevalence of acute deep vein thrombosis according to HIV status following major orthopaedic surgery at the University Teaching Hospital, Lusaka, Zambia

2019 ◽  
Vol 23 (3) ◽  
pp. 104-108
Author(s):  
Collin West ◽  
Yakub Mulla ◽  
James Munthali
Keyword(s):  
Deep Vein Thrombosis ◽  
Lower Limb ◽  
Orthopaedic Surgery ◽  
Hiv Positive ◽  
Negative Group ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
Hiv Seropositive ◽  
D Dimer ◽  
Hiv Negative

Background: Hypercoagulable states and immobilization following lower limb, pelvic, and spinal surgery increases the risk of deep vein thrombosis (DVT). It is also suggested that HIV alone increases the risk of deep vein thrombosis. However no study has been done to determine the prevalence of deep vein thrombosis in HIV seropositive individuals who have undergone lower limb orthopaedic surgery in the Zambian context. We therefore conducted this study to determine the prevalence of deep vein thrombosis in patients who are HIV seropositive in comparison to those who are HIV seronegative after undergoing lower limb orthopaedic surgery. Methods: A total of 42 Patients were enrolled. Of these 23 (54 %) were HIV negative controls and 19 (46 %) were HIV positive patients who underwent lower limb surgery or spinal surgery. Demographic and HIV status data was collected prior to surgery. After surgery a blood sample was tested for fibrinogen degradation products (D-dimer) levels. The patients were then monitored for the development of clinical DVT and those that developed clinical DVT had an ultrasound to confirm the diagnosis. Results: The majority (81%) of the study population were under the age of 50 years. The mean values of D-dimers were 2.33 ± 1.65 μg/ml for the HIV negative group and 2.55 ±1.50 μg/ml for the HIV positive group. The number of positive D-dimer results was similar in the two groups, 94.7% for the HIV cohort and 95.7% in the negative group (X 2 0.19 p=0.89). There was a positive correlation between the D-dimer value and the type of surgery done in both the HIV positive group (R 0.390 p = 0.049) and the HIV negative group (R 0.398 at p = 0.03). In both group’s hip and knee surgeries gave higher values of D-dimers. There was no statistical difference in the occurrence of a positive D-dimer and CD4 count (X2 0.95 p=0.89). The combined prevalence of clinical DVT confirmed by compression ultrasonography in the entire study population was 4.8%. The prevalence in the HIV seropositive group and HIV seronegative groups were 5.3% and 4.3% respectively (X2 0.19 p= 0.89). None of the patients received preoperative DVT prophylaxis due to cost but both patients that developed DVT received antithrombotic treatment. Conclusions: There was no significant difference in the prevalence of DVT between patients who were HIV seronegative and seronegative following major lower limb and spinal orthopaedic surgery. Both groups had raised D-dimer values. Keywords: deep vein thrombosis; HIV; D-dimer; Doppler ultrasound 

scholarly journals A CASE OF UPPER LIMB DEEP VEIN THROMBOSIS IN A KNOWN HIV PATIENT WITH NON HODGKINS LYMPHOMA

2021 ◽  
pp. 197
Author(s):  
Keyword(s):  
Deep Vein Thrombosis ◽  
Upper Limb ◽  
Hiv Positive ◽  
Thrombotic Risk ◽  
Hodgkins Lymphoma ◽  
Vein Thrombosis ◽  
Resource Setting ◽  
Non Hodgkins Lymphoma ◽  
Deep Vein ◽  
Limb Deep Vein Thrombosis

This is a case of upper limb deep vein thrombosis in a HIV positive patient who had also been diagnosed of Non-Hodgkins Lymphoma. This case highlights the importance of thromboprophylaxis and thrombotic risk assessment in all HIV positive as well as cancer patients particularly in low resource setting which are at risk of increased morbidity and mortality.

Perivascular Perfusion on Contrast-Enhanced Ultrasound (CEUS) Is Associated with Inflammation in Patients with Acute Deep Vein Thrombosis

2017 ◽  
Vol 117 (11) ◽  
pp. 2146-2155 ◽  
Author(s):  
Mathias Kaspar ◽  
Stephan Imfeld ◽  
Sasan Partovi ◽  
Markus Aschwanden ◽  
Thomas Baldi ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Inflammatory Markers ◽  
Thrombus Formation ◽  
Contrast Enhanced Ultrasound ◽  
Direct Evaluation ◽  
Vein Thrombosis ◽  
Contrast Enhanced ◽  
Acute Deep Vein Thrombosis ◽  
Deep Vein

Background Inflammatory processes of the venous wall in acute deep vein thrombosis (DVT) play a role in thrombus formation and resolution. However, direct evaluation of the perivascular inflammation is currently not feasible.Objective To assess perivascular perfusion in acute proximal DVT using contrast-enhanced ultrasound (CEUS) reflecting perivenous inflammation and its association with systemic inflammatory markers in a single-centre, prospective observational study.Patients/Methods Twenty patients with proximal DVT underwent CEUS imaging in the thrombosed and contralateral popliteal vein at baseline and after 2 weeks and 3 months. Perfusion was quantified by measuring peak enhancement (PE) and wash-in rate (WiR) in a perivenous region after bolus injection of the contrast agent. High-sensitive C-reactive protein (hsCRP) and interleukin-6 (IL-6) were determined at the time of each CEUS imaging.Results PE and WiR were significantly higher in the thrombosed compared with the unaffected leg at baseline (1,007 vs. 34 au and 103 vs. 4 au/s) and 2-week follow-up (903 vs. 35 au and 70 vs. 4 au/s). Compared with baseline, PE and WiR in the thrombosed leg significantly decreased to 217 au and 18 au/s at 3-month follow-up.At baseline, hsCRP and IL-6 were elevated at 20.1 mg/mL and 8.2 pg/mL and decreased significantly to 2.8 mg/mL and 2.6 pg/mL at 2-week follow-up, remaining low after 3 months. There was a weak association between the level of inflammatory markers and the CEUS parameters at baseline on the thrombosed leg.Conclusion Elevated perivascular perfusion assessed by CEUS imaging is associated with the inflammatory response in acute DVT.

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