Increased Thrombopoiesis and Platelet Activation in Hantavirus-Infected Patients

J Infect Dis. 2015 Oct 1;212(7):1061-9. doi: 10.1093/infdis/jiv161. Epub 2015 Mar 11.


Background: Thrombocytopenia is a common finding during viral hemorrhagic fever, which includes hemorrhagic fever with renal syndrome (HFRS). The 2 main causes for thrombocytopenia are impaired thrombopoiesis and/or increased peripheral destruction of platelets. In addition, there is an increased intravascular coagulation risk during HFRS, which could be due to platelet activation.

Methods: Thrombopoiesis was determined by quantification of platelet counts, thrombopoietin, immature platelet fraction, and mean platelet volume during HFRS. The in vivo platelet activation was determined by quantification of soluble P-selectin (sP-selectin) and glycoprotein VI (sGPVI). The function of circulating platelets was determined by ex vivo stimulation followed by flow cytometry analysis of platelet surface-bound fibrinogen and P-selectin exposure. Intravascular coagulation during disease was determined by scoring for disseminated intravascular coagulation (DIC) and recording thromboembolic complications.

Results: The levels of thrombopoietin, immature platelet fraction, and mean platelet volume all indicate increased thrombopoiesis during HFRS. Circulating platelets had reduced ex vivo function during disease compared to follow-up. Most interestingly, we observed significantly increased in vivo platelet activation in HFRS patients with intravascular coagulation (DIC and thromboembolic complications) as shown by sP-selectin and sGPVI levels.

Conclusions: HFRS patients have increased thrombopoiesis and platelet activation, which contributes to intravascular coagulation.

Keywords: disseminated intravascular coagulation; hantavirus; hemorrhagic fever with renal syndrome; platelets; thrombosis; viral hemorrhagic fever.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Blood Coagulation
  • Blood Platelets / physiology
  • Disseminated Intravascular Coagulation / blood*
  • Disseminated Intravascular Coagulation / physiopathology
  • Female
  • Fibrinogen / analysis
  • Hantavirus / physiology*
  • Hemorrhagic Fever with Renal Syndrome / blood*
  • Hemorrhagic Fever with Renal Syndrome / physiopathology
  • Humans
  • Kinetics
  • Male
  • Middle Aged
  • P-Selectin / blood
  • Platelet Activation*
  • Platelet Count
  • Thrombocytopenia / blood*
  • Thrombocytopenia / physiopathology
  • Thrombopoiesis*
  • Thrombopoietin / blood


  • P-Selectin
  • SELP protein, human
  • Fibrinogen
  • Thrombopoietin