Thrombocytopenia in leptospirosis: the absence of disseminated intravascular coagualation - abstract

ABSTRACT

This study was undertaken to test the hypothesis that thrombocytopenia in patients with severe leptospirosis is due to Disseminated Intravascular Coagulation (DIC). Twenty-four patients with leptospirosis were admitted to Queen Elizabeth Hospital between October 1, 1983 and September 30, 1984. All patients had serial measurements of haemoglobin, platelet count, blood smear, PT, PTT, fibrin degradation products (FDP's), thrombin time, fibrinogen titre, C3, C4, bleeding time, haptoglobin and bilirubin. Thirteen (54 percent) patients had thrombocytopenia (platelet count <100,000/cæ mm) and 23 (96 percent) were jaundiced with a mean serum bilirubin concentration of 196 æ mol/l (range 17-624 æ mol/l (normal <17 æ mol/l). There were mild elevations of C3, C4 and serum haptoglobin. Three thrombocytopenic and one patient with normal platelet count had a one-second elevation of PT. All four patients demonstrated normal PT's on subsequent days although the platelet count in the 3 thrombocytopenic patients was still decreased. FDP's were elevated in 63 percent of non-thrombocytopenic and 64 percent of thrombocytopenic patients. The elevation was mild it was above 10 æg/ml (normal <7.5) in one patient. Non-leptospiral jaundiced patients also had elevation of FDP's. All other variables tested were normal. It is concluded that there is no evidence for disseminated intravascular coagulation in leptospirosis since the expected concomitant changes indicative of a DIC did not accompany thrombocytopenia. It is suggested that the marginal elevation of FDP's seen in our patients is due to hepatic dysfunction (AU)