Circulating Naturally-Occurring Anticoagulants before Treatment and after Recovery from SARS-CoV-2 Infection in Ghana

Charles Nkansah, Lawrence D. Agyemang, Felix Osei-Boakye, Samuel K. Appiah, Kofi Mensah, Gabriel Abbam, Simon B. Bani, Samira Daud, Hisham A. Osumanu, Charles A. Derigubah, Dorcas Serwaa, Francis A. Apodola, Ezekiel B. Ackah, Michael O. Tetteh, Nurain Abdul-Kareem, Fatima P. Abubakar, Candy A. E. Wilson, David A. Afrifa, Yasir Ishaq, Ruth A. A. Wedam, Fremah P. Agyeman-Duah, Kingsford O. Appiah, Yeduah Quansah, Peace E. Agbadza, Clement B. Dagungong, Michael Owusu, Felix E. Chukwurah


Background: Disturbance in naturally-occurring anticoagulants may contribute to the hypercoagulable state in COVID-19. This study determined the plasma antigen levels of protein C (PC), protein S (PS), antithrombin-III (AT-III), and thrombomodulin (TM) before treatment and after recovery from COVID-19. Materials and Methods: This cross-sectional study, conducted from February to August 2022 at Kumasi South Hospital, recruited sixty-five RT-PCR-confirmed COVID-19 participants. A venous blood sample was taken for full blood count (FBC) analysis using a 3-part fully automated haematology analyzer, and PC, PS, AT-III, and TM antigen levels measured using ELISA. The data were analyzed using SPSS version 26.0. P<0.05 was considered statistically significant. Results: Severe COVID-19 participants had relatively lower haemoglobin (p<0.001), RBC (p<0.001), HCT% (p<0.001) and platelets (p<0.001), but higher RDW-CV% (p=0.013), WBC (p<0.001), and absolute lymphocyte counts (p<0.001) compared to those with the non-severe form of the disease. The overall prevalence of anaemia among the participants was 58.5%, and 32 (84.2%) and 6 (15.8%) of the anaemic participants had mild and moderate anaemia respectively. Protein C (p<0.001), PS (p<0.001) and ATIII (p<0.001) levels were lower among the severe COVID-19 participants than in the non-severe group. But severe COVID-19 group had higher TM levels (p<0.001) than the non-severe group. Again, participants had higher haemoglobin (p<0.001), RBC (p<0.001), HCT% (p=0.049), absolute neutrophil count (p<0.001) and platelets (p<0.001) after recovery from COVID-19 than the values on admission. Additionally, after recovery, participants had higher levels of PC (p<0.001), PS (p<0.001), and ATIII (p<0.001), but reduced TM (p<0.001). Conclusion: Severe COVID-19 patients had higher PC, PS, and AT-III, but lower TM levels. The changes in circulating anticoagulants may contribute to the hypercoagulable state of COVID-19. Blood cell indices are negatively affected during COVID-19. Complete recovery from the SARS-CoV-2 infection normalised the haematological indices. Assessment of naturally-occurring anticoagulants and the provision of anticoagulants are recommended in the management of COVID-19.


Doi: 10.28991/SciMedJ-2022-04-04-01

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Anaemia; Antithrombin-III; COVID-19; Protein C; Protein S; Thrombomodulin.


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DOI: 10.28991/SciMedJ-2022-04-04-01


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Copyright (c) 2023 Charles Nkansah, Lawrence Duah Agyemang, Felix Osei-Boakye, Samuel Kwasi Appiah, Kofi Mensah, Gabriel Abbam, Simon Bannison Bani, Samira Daud, Hisham Alhassan Osumanu, Charles Angnataa Derigubah, Dorcas Serwaa, Francis Atoroba Apodola, Ezekiel Bonwin Ackah, Michael Ofoe Tetteh, Nurain Abdul-Kareem, Fatima Princess Abubakar, Candy Adwoa Ewusiwaa Wilson, David Amoah Afrifa, Yasir Ishaq, Ruth Ama Azuwe Wedam, Fremah Portia Agyeman-Duah, Kingsford Owusu Appiah, Yeduah Quansah, Peace Esenam Agbadza, Clement Binwatin Dagungong, Michael Owusu, Felix Ejike Chukwurah