Coagulopathyis an abnormal bleeding disorder in which the blood’s ability to clot is impaired resulting to prolonged bleeding. Studies have shown a relationship between coagulopathy with many infections such as HIV viral infection after treatment.

Specific Objective: The study aims to determine the haemostatic changes in TB treatment naive HIV Negative patients initiating Anti TB Medications at Thika Level Five Hospital in Kiambu County of Kenya.

Design: Prospective study design was used by carrying out Prothrombin time (PT) and Alternate Partial Thromboplastin Time (aPTT) among TB patients before and after treatment.

Subjects: A total of 197 TB positive patients attending Thika level five hospitals TB clinic were recruited.

Method: With acquisition of eight milliliters of blood, samples were analyzed for Prothrombin Time Test and Activated Partial Thromboplastin Time Test prior to initiation of anti TB medication and after initiation of treatment.

Results: showed Significant differences in prothrombin time in age groups 42-49, 55-65 and above 66 years with p-values of 0.021, 0.000, and 0.000 respectively at 95 % confidence level before and after treatment. Age group above 66 years old showed significantly lower Activated Partial Thromboplastin Time after anti TB administration as compared to when they were naïve (p=0.000).

Conclusion: The study concluded that significant hemostatic changes occur after anti TB medication and recommended. Health Care providers should be aware of the haemostatic Changes that occur in TB Patients initiating treatment andcarry out these haemostatic tests and initiate treatment as soon asany problem is identified.

Keywords: Coagulopathy, Haemostatic changes, Prothrombin Time test, Activated Partial Thromboplastin time.

1. Hoffman R, Benz E,Silberstein L, Heslop H, Weitz J, Anastasi (2012). Haematology: Basic Principles and Practice (6 Ed.). Elsevier Saunders. Chap. 144).
2. Hoffbrand AV, Moss PA, Pettit JE. (2006). Essential Haematology: Fifth edition: pp. 264 – 319.
3. Guidelines for Management of Tuberculosis and Leprosy in Kenya.July 2013 edition.pp. 1 – 27.
4. Toh CH. (2003) Biphasic transmittance waveform in the APTT coagulation assay is due to the formation of a Ca (++)-dependent complex of C-reactive proteinwith very-low-density lipoprotein and is a novelmarker of impending disseminated intravascular coagulation. Blood, 100(7): p.2522-9.
5. Raghava SR, Vishak AK, Vinaya P. (2007).A Rare Complication of Pulmonary Tuberculosis. Journal, Indian Academy of Clinical Medicine, 2007; 8(2): 179-81)
6. Shah PA, Yaseen Y, Malik AH. (2011). Pulmonary Tuberculosis with Deep Venous Thrombosis. Webmed Central general medicine, 2(8):WMC002093
7. Priĭmak AA, Makinskiĭ AI, Ivanko TP, Makarova VV, Makovetskiĭ VV. (1995). Journal on Hemostasis disorders in patients with pulmonary tuberculosis.
8. Lin MT, Wang JY, Yu CJ, Lee LN, Yang PC. (2014). Retrospective study on Mycobacterium tuberculosis inducing disseminated intravascular coagulation. International Journal of Science and Research Volume 3 Issue 7, July 2014.
9. Kothari H, Rao LV, Vankayalapati R, Pendurthi U. (2012). Mycobacterium Tuberculosis Infection and Tissue factor Expression in Macrophages. 2012. Dol:10.1371/journal.pone.0045700.
10. Nagayama N, Shishido Y, Masuda K, Baba M, Tamura A, Nagai H. (2004). Leukopenia due to anti-tuberculous chemotherapy including rifampicin and isoniazid.  2004; 79(5):341–8
11. Baynes R, Flax H, Bothwell T, Bezwoda W, Mac Phail A, Atkinson P. (1986). Haematological and iron‐related measurements in active pulmonary tuberculosis. Scand J Haematol. 1986;36(3):280–7
12. Guidelines for the Management of Adverse Drug Effects of Antimycobacterial Agents (1998). P 19 – 48.
13. Kassa D, Leonie R, Weldemeskel W, Tebeje M, Alemu A, Alemayehu Y, Gebremichael G, Selase A, Tegbaru B, Wolday D, Messele T, Baarle D. (2012). A study on Clinical, Hemato-Immunological Characteristics of Mycobacterium tuberculosis Patients with and without HIV-1 Infection: Responses to Six Month Tuberculosis Treatment. Biomed Int (2012) 3:22-33.
14. Taramian S, Joukar F, Asgharnezhad M, Biabani A, Mansour Ghanaei F. (2012). Side Effects of First-line Anti Tuberculosis Drugs. Journal of Guilan University of Medical Sciences. Journal of Guilan University of Medical Sciences, No: 85.
15. Naithani R, Agrawal N, Choudhary VP. (2007).Deep venous thrombosis associated with tuberculosis. Blood Coagul. Fibrinolysis 2007; 18:377-80. PUBMED. 
16. Aditya S, Naresh G, Sandeep G, Harmanjit S. (2017).A Study of Haematological and Haemostasis Parameters and Hypercoagulable State in Tuberculosis Patients in Northern India and the Outcome with Anti-Tubercular Therapy. doi: 7860/JCDR/2017/24022.9249

Nicholas Maina Muraguri

County Government of Kiambu, Department of Health Services, P.O. Box 6068 – 01000 Thika, Kenya