Investigating clotting changes in patients from Steve Biko Academic Hospital with intracerebral haemorrhage by studying the viscoelastic and ultrastructural properties of whole blood.

Abstract

Patients with intracerebral haemorrhage (ICH) have an increased risk of experiencing clotting changes when compared to healthy individuals, with recent research indicating that a bleeding event may enhance the prothrombotic effects of ICH. Although the effects of inflammation on the properties of whole blood (WB) in these patients have been studied extensively, there is a scarcity of research on the effects of ICH on the haemorheological-, and morphological properties of WB in patients with ICH. Therefore, this study utilised microscopy and viscoelastic techniques to examine clotting in these patients, in order to obtain a better understanding of the changes in clot formation in ICH patients. This may give more insight into thrombotic risk assessment and management. Whole blood from traumatic ICH (TICH) and non-traumatic ICH (NTICH) patients were compared to healthy controls. For a haematological overview of the ICH patients, routine clinical test results were utilised. Light microscopy (LM) was used to quantify the amount of deformed red blood cells (RBCs) present in each patient group. Scanning electron microscopy (SEM) was used to study the ultrastructural changes in blood cells and formed clots. Thromboelastography (TEG®) was used to study the changes in clot kinetics during clot formation. Results from the full blood count and C-reactive protein (CRP), demonstrated a tendency toward inflammation in both patient groups. No significant difference was seen in RBC deformation in both groups compared to the controls, indicating there was no significant RBC deformation in the patient groups. Ultrastructural studies on RBCs using SEM in both patient groups showed fine membrane changes and increased aggregation when compared to healthy controls. Platelets (PLTs) also appeared to be spread and fibrin fiber formation was disorganised. Viscoelastic results showed that clots formed faster in ICH patients, with increased strength and rigidity, thus revealing a hypercoagulable nature during clotting in these patient groups. The results of this study have revealed the marked differences in coagulation and associated blood components in TICH and NTICH patients compared to healthy controls. They provide a greater understanding of clot dynamics that could contribute to an increased risk of thrombotic events, traceable through viscoelastic techniques. This justifies further investigation into the utilisation of these techniques in a clinical, point-of-care setting, in order to enhance the prevention and management of thrombotic events in these patients.