Investigating clotting changes in intracerebral haemorrhage patients from Steve Biko Academic Hospital by studying the viscoelastic and ultrastructural properties of platelet-poor plasma

Abstract

Intracerebral haemorrhage (ICH) is a major neurological condition that affects individuals of all age groups, gender, economic status and geographical location. Compared to healthy individuals, patients with ICH have an increased risk of coagulation complications. Previous studies have conducted research on the effects of ICH on the haemorheological, morphological and inflammatory properties of whole blood (WB) in patients with ICH. In contrast, there has been limited research on the properties of platelet-poor plasma (PPP) changes in ICH patients. Therefore, this study aims to investigate the ultrastructural and viscoelastic properties in PPP of ICH patients to identify any coagulation changes that might be linked to the complications in ICH. This will allow for a better understanding of thrombosis management and risk assessment. The study compared the PPP of spontaneous ICH (S-ICH) and traumatic ICH (T-ICH) patients to healthy controls. The methods used include scanning electron microscopy (SEM), which provided morphological data on the fibrin fibres, focusing on the fibres' thickness, network and branching. The kinetics of clot formation were investigated using thromboelastography® (TEG®). The C-reactive protein (CRP) and procalcitonin (PCT) markers from ICH patients were used to determine inflammation status in these patient groups. Both ICH patient groups demonstrated a tendency towards inflammation based on the clinical data. Clot strength and rigidity increase revealed a hypercoagulable state in both ICH patient groups based on the TEG® results. Based on the SEM results the S-ICH group displayed thinner fibrin fibres, with a tighter network. While the T-ICH group displayed thicker fibrin fibres and looser networks. Overall, these results revealed that there are differences in the blood components and coagulation in ICH patients compared to healthy controls. The findings, which are based on viscoelastic techniques, help to understand the clot dynamics that may increase the risk of thrombotic events. The results reinforce the necessity of conducting additional research into the role of ICH in relation to the characteristics of PPP among patients with ICH. The overall results of this study could assist in preserving the lives of patients suffering from ICH and also ensure the maintenance of their quality of life.