FROM TRANEXAMIC ACID TO RESCUE THERAPY OF ETAMSYLATE IN THE MANAGEMENT OF PERSISTENT HEMATURIA IN LASSA FEVER IN ONDO STATE, NIGERIA: A CASE SERIES SURVEY

Lassa fever is an acute viral hemorrhagic illness endemic to West Africa and remains a major public health challenge in Nigeria, particularly in Ondo State where annual outbreaks occur. Hematuria is a recognized complication linked to endothelial dysfunction, capillary fragility, and platelet impairment. Tranexamic acid (TXA) is frequently used as an adjunct hemostatic agent, but evidence supporting its effectiveness in Lassa-related bleeding is limited. Etamsylate, a capillary-stabilizing agent that enhances primary hemostasis, has shown potential benefits in various bleeding conditions, yet its role in viral hemorrhagic illnesses remains largely undocumented. These case series report three adults who were PCR-confirmed cases of Lassa fever presenting with gross hematuria. Patients were admitted and received standard ribavirin therapy and tranexamic acid for five days, but the hematuria persisted without improvement. After switching to etamsylate (dicynone), the three patients showed rapid clinical response, with significant reduction in hematuria within 24–48 hours of switching to the therapy and complete resolution by days 4–6. No adverse reaction was recorded for the three patients. The findings suggest that tranexamic acid may be inadequate for Lassa fever–associated hematuria, whereas etamsylate appears more effective. Further studies are recommended to clarify its therapeutic role.