ACUTE-PHASE RESPONSE AND THE HYPERCOAGULABLE STATE IN PULMONARY TUBERCULOSIS

In our experience, severe pulmonary tuberculosis (PTB) is often compli cated by deep venous thrombosis (DVT). Because of the association betw een inflammation and haemostatic changes that can result in a hypercoa gulable state, we have prospectively examined such predisposing factor s in representative patients. Sequential analyses in a control group w ith active PTB showed anaemia, thrombocytosis, elevations in plasma fi brinogen, fibrin(ogen) degradation products (FDP), tissue plasminogen activator (t-PA) and inhibitor (PAI-1) with depressed antithrombin III levels. Age, sex and disease matched individuals with venographically proven DVT had higher FDP (15.8 +/- 14.3 v 3.2 +/- 1.7 mu g/ml: P < 0 .01), t-PA (19.4 +/- 14.9 +/- 11.3 +/- 0.8 ng/ml: P < 0.01), and funct ional PAI-1 activity (11.6 +/- 6.3 v 4.2 +/- 4.1 : P < 0.01) with lowe r platelet counts (347 +/- 110 v 563 +/- 230 x 10(9)/l:P < 0.01). Fibr inogen levels in all patients rose during the first 2 weeks of therapy and, together with related disturbances, corrected within 12 weeks. I n conclusion, elevated plasma fibrinogen with impaired fibrinolysis co upled with a decrease in antithrombin III and reactive thrombocytosis would appear to favour the development of DVT in PTB.