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Hemostasis in Yellow Fever: results from the 2018 outbreak in Brazil

1Faculty of Medicine, Universidade Federal de Minas Gerais, Brazil, Belo Horizonte, Minas Gerais, Brazil, 2Hemocentro de Belo Horizonte, Fundação HEMOMINAS, Belo Horizonte, Minas Gerais, Belo Horizonte, Minas Gerais, Brazil, 3University Hospital, Universidade Federal de Minas Gerais, Brazil, Belo Horizonte, Minas Gerais, Brazil, 4Hospital Eduardo de Menezes, Belo Horizonte, Minas Gerais, Brazil, Belo Horizonte, Minas Gerais, Brazil, 5Department of Internal Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil, Belo Horizonte, Minas Gerais, Brazil

Abstract Number: PB1023

Meeting: ISTH 2022 Congress

Theme: Coagulation and Natural Anticoagulants » Hemostasis and Organ Dysfunction

Background: Between 2017-2018, Brazil faced the most expressive yellow fever(YF) outbreak, with 1,266 cases confirmed in humans and 415 deaths. YF is a viral fever which can evolve with a severe bleeding diathesis. To date, very few studies have investigated the hemostasis in these patients.

Aims: To perform a full evaluation of bleeding manifestations, death and hemostasis profile.

Methods: We evaluated clinical and laboratory characteristics of patients with YF admitted to a local hospital between December/2017-April/2018.

Results: We included 46 patients, 34 with severe (SYF) and 12 with moderate (MYF) disease. Most were male (89%), median age 46 years (IQR,38-53). A total of 12 (26%) died, all had SYF. At admission, median AST was 1,025 (IQR,266-4219) and creatinine 1.4 (IQR,0.8-2.5). A total of 59% versus 8% of patients with SYF versus MYF had bleeding, respectively (p=0.003). Patients with SYF presented lower platelet counts (p=0.001), more prolonged aPTT (p=0.03), TT(p=0.005), higher D-dimer (p < 0.0001) and lower plasma levels of factors II (p=0.0003), IX (p=0.01) and X (p=0.04). When compared with patients discharged alive, those who died presented more major bleeding(p=0.03), hepatic encephalopathy (p=0.002) and renal failure (p=0.001). The INR(p=0.003) and the aPTT (p=0.002) were higher in SYF who died when compared with SYF who were discharged. SYF who died presented lower plasma levels of factors II (p=0.02), V(p=0.001), FVII (p=0.005) and IX(p=0.01). There was no difference in the levels of factor VIII, X or fibrinogen between patients who died and the ones discharged alive. Most patients (91%) had fibrinogen at normal levels and all patients presented increased TT.

Conclusion(s): Patients with YF develop a coagulopathy associated with deficiency of procoagulant factors of hepatic synthesis. Enlarged TT and aPTT and reduced factors II, V, VII, IX were associated with death in a univariate analysis. This is the first evaluation of a complete profile of hemostasis in YF.

To cite this abstract in AMA style:

Jardim L, Brandão Franco M, Carvalho B, Basques F, RIbeiro D, Gallo L, Rezende S. Hemostasis in Yellow Fever: results from the 2018 outbreak in Brazil [abstract]. https://abstracts.isth.org/abstract/hemostasis-in-yellow-fever-results-from-the-2018-outbreak-in-brazil/. Accessed September 22, 2023.

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