“Ultrastructural changes of platelets in COVID-19 and chronic viral hepatitis patients “

ABSTRACT

Platelet-viral interactions are evolving as a new concern. Coagulation disorder is a major consequence of the COVID-19 infection. In chronic hepatitis virus infections, defect in coagulation factors, thrombocytopenia and platelet function abnormalities are common. A SARS-CoV-2 infection on top of chronic viral hepatitis infection can be common in areas where viral hepatitis is endemic. Here, we investigate the platelet ultrastructural changes and estimate the serum platelet factor-4 (PF-4), ferritin, CRP, and D-dimer in COVID-19 patients (n = 60), COVID-19 patients with associated chronic viral hepatitis (n = 20), and healthy subjects (n = 20). Ultrastructural changes were demonstrated in all test groups, denoting platelet activation. In chronic viral hepatitis patients, Platelet ultrastrustural apoptotic changes were also seen. Significantly high levels of PF-4 were confirmed in moderate and severe COVID-19 patients (P.value <0.001), with a cut off value of 17 ng/ml for predicting disease severity. A positive correlation of PF-4 with the level of serum ferritin, CRP, and D-dimer (p value < 0.001) was noted, while negatively correlated with platelet count and platelet granule count (p value < 0.001). In our study, chronic viral hepatitis patients presented mild COVID-19 signs, and their PF-4 level was comparable with the subgroup of mild COVID-19 infection. The platelet’s critical role in COVID-19 coagulopathy and chronic viral hepatitis is evidenced by the ultrastructural changes and the high levels of PF4. Moreover, a dual viral infection poses a substantial burden on the platelets, necessitating close monitoring of the patient’s coagulation profile.

KEYWORDS:

• Chronic viral hepatitis
• COVID-19
• Platelets activation

Acknowledgments

This work would not have been possible without the support of both the electron microscopy department, TBRI and Faculty of medicine, Ain Shams University.

Author contributions

Nagwa AbdelKhalek ElKhafif. Put the conception and design of the study; Ayat SalahEldin Hassan and Salma Hegab performed the practical work of the study; Nagwa AbdelKhalek ElKhafif, Ayat SalahEldin Hassan, Noha Bassiouny and Sahar AboGaziah revised and analyzed the results; Nagwa AbdelKhalek ElKhafif and Ayat SalahEldin Hassan analyzed and interpreted the ultrastructural data; Heiba EzzElregal was primarily responsible for selection and recruitment of the patients, Nagwa AbdelKhalek ElKhafif, Ayat SalahEldin Hassan were primarily responsible for writing the manuscript, drafting of the paper, revising it critically for intellectual content; and the final approval of the version to be published; and all authors agree to be accountable for all aspects of the work.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethical approval

The study was approved by faculty of medicine, Ain Shams University ethics committee, under federal wide assurance no. FWA000017585. Written consent was granted in all cases.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.