Determination of Coagulopathy in Tuberculosis Patients Initiating Anti - Tb Medication at Thika Level Five Hospital, Kenya.

Abstract

Coagulopathy is an abnormal blood bleeding disorder in which the blood’s ability to form clots is mostly impaired. This condition can cause a tendency toward excessive bleeding occurring spontaneously or resulting from injury. Coagulopathies are common all over the world. Several studies have shown a relationship between coagulopathy with other infections such as HIV viral infection especially after treatment. Determining coagulopathy among TB patients before and after treatment will help in the appropriate therapeutic management of these patients. The study aimed to determine the haemostatic changes in TB treatment naive patients initiating anti TB Medications at Thika Level Five Hospital in Kiambu County of Kenya. These changes were determined by carrying out Prothrombin time (PT), Alternate Partial Thromboplastin Time (aPTT), D - dimer and platelet count tests among TB patients before and after treatment. A total of 197 TB positive patients attending Thika level five hospital TB clinic were recruited in this study upon consenting. Clinical and demographic information of the participants were obtained using a structured questionnaire. With acquisition of eight milliliters of blood, samples were analyzed for Prothrombin time test, Activated partial thromboplastin time test, D-dimer test and platelet count prior to anti TB medication being initiated and after initiation of treatment. Results showed Significant differences in prothrombin time in age groups 42-49, 55-65 and above 66 years with p-values of 0.021, 0.000, and 0.000 respectively at 95 % confidence level. Age group above 66 years old showed significantly lower aPTT after anti TB administration as compared to before treatment (p=0.000), significant increase in D-dimer test in all participant TB positive patients after anti TB administration as compared to those determined before treatment. All the age groups exhibited normal D-dimer concentrations except for the 58-65-year old who presented elevated levels from 448.50±78.20, before treatment to 738.90±32.00 after treatment. (p=0.037; 95 % CI), Age group 66 years and older, there was a significance decrease in platelet count after treatment as compared with the baseline values (p = 0.000). However, there were no significant changes in platelet count in all the age groups. Data was analyzed using the SPSS statistical software version 22, Minitab statistical software version 19 and graph pad prism version 8. Significant haemostatic changes were identified in TB patients initiating TB treatment. This included significant elevation of Prothrombin time and D-Dimer. There was significant association in Prothrombin time test on patients initiating TB treatment. Significant association on D-Dimer test was noted on TB patients initiating treatment. There was no significant association in Activated partial Thromboplastin Time on patients initiating TB treatment. No significant association in Platelets count on patients initiating TB treatment.