Assessment of Coagulopathy, Inflammation and LDH Activity in SARS-CoV-2-infected Patients

The patho-physiology of COVID19 is still not clear. This study investigated the status of coagulation, LDH activity, and inflammation in SARS-CoV-2 infected patients. One hundred and thirty-four newly diagnosed COVID19 infected patients (age ranged65-82years) attending Mullingar Regional Hospital, Mullingar, Republic of Ireland, volunteered to participate in this study. They all presented with a pulmonary disorder, pyrexia, vomiting, body pains, etc. SARS-CoV-2 confirmatory test was done with RT-PCR molecular test using Cepheid Genexpert System. The data of another 121 plasma samples of apparently normal, non-COVID19 infected individuals taken before the emergence of COVID19 served as controls. Levels of blood platelets was determined in the participants using Siemen ADVIA 2120 Haematological System, and plasma D-dimer was determined in the participants using Star Max-Stago–Automatic Coagulation Analyzer LDH activity, plasma ferritin, and C-reactive protein (CRP) were determined in the participants using Beckman AU680-Chemistry Analyser. SARS-CoV-2 –infected patients showed significantly (p<0.001) higher levels of D-dimer (1522.95+1395.45ng/ml), CRP (125.3+116.4mg/l), ferritin (488.5+514.9pg/l), and LDH activity (574.4+446.7iu/l) compared to controls (78.8+18.1ng/ml, 2.4+1.7mg/l, 61.3+58.2pg/l, 304.1+76.6iu/l respectively). The blood platelet count did not show significant (p>0.05) change in the COVID19 patients (252.2 x 109+101 x 109) compared to controls (256.4 x 109+63.2 x 109). Elevated LDH activity could indicate tissue breakdown in the SARS-Cov-2 infected patients. Hyper-coagulation and inflammation are imminent in the COVID19 patients. Adjuvant anticoagulant and anti-inflammatory therapies may be useful as part of therapeutic regimen in the SARS-CoV-2 infected patients. Keywords: COVID19, Coagulopathy, CRP and ferritin, LDH.

In vitro haemostatic efficacy of aqueous, methanol and ethanol plant extracts of three medicinal plant species in Palestine

The haemostatic efficacy of different extract types of Satureja thymbra L., Thymbra spicata L. (Lamiaceae) and Verbascum fruticulosum Post. (Scrophulariaceae) was evaluated in this study via the Prothrombin time (PT) and Activated partial thromboplastin time (aPTT) analysis. Aqueous, methanol and ethanol extracts of the examined plant species leaves were prepared to a final concentration 50 mg/mL. In vitro PT and aPTT assays were conducted on normal platelet poor plasma blood samples by a digital coagulation analyzer. The obtained results revealed anticoagulation activity of all investigated plant species with observed variations among them. The aqueous and ethanol extracts of T. spicata as well as the aqueous extract of S. thymbra prolonged PT values significantly (p < 0.05). While, all V. fruticulosum extract types have had no significant effect on the PT values. The recorded aPTT data showed that all aqueous extracts have had a significant effect on the blood haemostasis as they increased aPTT values in all plant species under study. Out of which, both the ethanol and methanol extracts of T. spicata and methanol extract of S. thymbra showed similar effect. Of great concern, it was clearly noticed that the aqueous and ethanol extract of T. spicata and the aqueous extract of S. thymbra possess the strongest anticoagulation effect as they increased both PT and aPTT values significantly relative to the control (p < 0.05). The variable anticoagulation bioactivity among the studied plant species could be referred to the various solvents degrees of solubility of different phyto-constituents. Thus, the efficacy of the plant species extracts evaluation as anticoagulants or coagulants were related to the plant species and to the solvent of extraction.

Coagulation testing: Comparison of portable (CoaguChek® XS) and automated coagulation analyzer in healthy cats

Background and Aim: The CoaguChek® XS (CCX) is a portable coagulation analyzer that is widely used to monitor prothrombin time (PT) in human patients taking oral anticoagulants. It can also be reliably used for screening dogs when PT is in the normal range. Efficacy of the portable CCX coagulation analyzer was evaluated for testing PT in healthy cats and the normal range was established. Materials and Methods: Blood samples of 82 cats were collected from the jugular vein and PT was measured using both the CCX and an automated coagulation analyzer (ACA). Spearman's correlation was used to measure the strength and direction of association between the two analyzers, while limits of agreement were assessed utilizing Bland-Altman analysis. Results: Range of PT using the CCX was 10.1-14.1 s. Correlation between the two analyzers was moderate but significant (r=0.3465, p=0.0014). Mean difference between CCX-PT and ACA-PT was 1.624 s and standard deviation was 0.890 with 95.1% of the samples falling within the limits of agreement. Conclusion: The CCX is a portable, easy to use coagulation analyzer that requires a small volume of blood and gives results within 1 min. Results showed moderate correlation and good agreement with a standard automated laboratory analyzer. The CCX can be used for screening coagulation testing when PT is in the normal range for cats. However, testing accuracy of the CCX in abnormal PT cats should be further investigated before diagnostic coagulopathy applications.