Features of hemorheological disorders in patients with alopecia associated with coronavirus infection

Objective: to study changes in hemostasis parameters and electrical, viscoelastic parameters of erythrocytes in patients with alopecia associated with a novel coronavirus infection (COVID-19).
Material and methods. We examined 76 females with alopecia that developed 3-6 months post COVID-19 (mean age 50.2±12.6 years), including 52 (68.4%) with telogen alopecia, 8 (10.5%) with androgenetic alopecia, 11 (14.5%) with anagen alopecia, and 5 (6.6%) with focal alopecia. The electrical and viscoelastic parameters of erythrocytes were studied by dielectrophoresis in an inhomogeneous alternating electric field at four fixed frequencies: 5х104 Hz, 105 Hz, 5х105 Hz, and 106 Hz using an electro-optical cell detection system. Hemostasis system parameters were studied by standard methods.
Results. The study revealed changes in the electrical and viscoelastic parameters of erythrocytes in patients with alopecia associated with COVID-19: a marked decrease in cell surface charge reflected by reduced levels of cell-to-electrode velocity (p=0.0002), dipole moment (p<0.0001) with an increased tendency to form aggregates (p<0.0001), statistically significant decrease in deformation ability (p<0.0001) against the background of increased generalized viscosity (p<0.0001) and rigidity (p=0.0004); the predominance of immature cells with a reduced mean diameter (p=0.005), an increased proportion of spherocytes (p<0.0001), deformed cells (p<0.0001) with reduced polarizability (p=0.0001–0.013), with high readiness for hemolysis at different electric field frequencies (p=0.003–0.043), with significantly altered structure of erythrocyte membranes associated with their thickening (low capacitance p<0.0001) and increased ability to conduct electric current (increased electrical conductivity; p<0.0001). Intravascular changes indicated activation of cellular hemostasis and the coagulation system with the development of compensated intravascular coagulation and microthrombosis (according to the leukocyte-platelet aggregation test and Willebrand factor activity (p<0.0001). The increase in the activity of the Willebrand factor was pronounced, reflecting the course of endotheliitis. An increase in intravascular coagulation was found, as measured by the level of soluble fibrin-monomer complexes (p<0.0001). There was a slight consumption of fibrinolysis factors during intravascular fibrin lysis according to Hageman-dependent fibrinolysis (p=0.039). Intravascular coagulation was stimulated by inflammatory process and statistically significant increase in fibrinogen level (p=0.004). The influence of immune reactions on changes in the activity of lupus anticoagulants (antiphospholipid antibodies) (p<0.0001) was revealed, but their participation did not determine the course of the process, falling within the framework of a non-specific immune response. Changes in the cellular component, endothelium and leukocytes were dominant in the activation of hemostasis, and the role of autoantibodies was not decisive.
Conclusion. The observed hemorheological changes can be regarded as one of the pathogenetic factors of the development of alopecia associated with coronavirus infection, and should be taken into account when choosing management strategy.
Keywords: alopecia, coronavirus infection, rheology, hemostasis, electrical, viscoelastic parameters, erythrocytes, dielectrophoresis, hypoxia, intravascular coagulation, microthrombosis
Conflicts of interest. The authors have no conflicts of interest to declare. Funding. The work was carried out under the State assignment within the framework of the budget theme “Study of molecular genetic and molecular biological mechanisms of development of common therapeutic diseases in Siberia to improve approaches to their early diagnosis and prevention”, 2024-2028 (FWNR-2024-0004).