Abstract:Background: Tuberculosis (TB) is a major public health concern, affecting millions worldwide, particularly in developing countries. While primarily a pulmonary disease, TB has significant systemic effects, including hematological and hemostatic alterations. These abnormalities may contribute to disease severity, complications, and treatment response. However, limited literature is available on the association between TB and hypercoagulable states.
Aim: To evaluate the hematological and hemostatic changes in tuberculosis patients, determine the presence of a hypercoagulable state, and assess the impact of anti-tubercular therapy (ATT) on these parameters.
Methods: A prospective interventional study was conducted at Madha Medical College, Chennai, from November 2015 to October 2016. A total of 150 newly diagnosed TB patients, aged ≥12 years, who had not started ATT were included. Patients were divided into four subgroups based on TB site (Pulmonary, CNS, Disseminated, and Others). Hematological (Hb, WBC, Platelet, ESR, LDH, CRP, Albumin) and hemostatic (PT, APTT, Factor VIII, Fibrinogen, D-Dimer) parameters were measured before and after two months of ATT. Standard WHO-recommended ATT regimens were administered. Statistical analysis was performed using paired t-tests in SPSS software to assess treatment effects.
Results: Significant improvement in hematological parameters post-ATT:Hemoglobin increased (p<0.01), indicating resolution of anemia.WBC count decreased (p<0.01), reflecting reduced inflammation.Platelet count decreased (p<0.01), suggesting improvement in hypercoagulability.ESR and CRP levels significantly decreased (p<0.01), confirming reduction in systemic inflammation.Coagulation profile showed a hypercoagulable state in TB:Fibrinogen and D-Dimer levels were elevated at baseline and significantly decreased after ATT (p<0.01), reducing thrombotic risk.Factor VIII levels remained unchanged (p=0.89), indicating persistent endothelial activation in some patients.Subgroup Analysis:Pulmonary TB patients showed the most improvement, while disseminated TB cases had slower recovery, indicating the need for longer follow-up.
Conclusion: TB induces significant hematological and coagulation abnormalities, contributing to a hypercoagulable state. ATT leads to marked improvements, particularly in anemia, inflammation, and thrombotic risk. However, some coagulation markers remain elevated, suggesting the need for continued monitoring and potential anticoagulation strategies in high-risk patients. This study underscores the importance of hematological and coagulation screening in TB patients to optimize treatment outcomes and prevent complications.