{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T08:06:48Z","timestamp":1777622808219,"version":"3.51.4"},"reference-count":51,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T00:00:00Z","timestamp":1773619200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"vor","delay-in-days":44,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"DOI":"10.1038\/s41598-026-42484-1","type":"journal-article","created":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T16:49:09Z","timestamp":1773679749000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hematologic and coagulation responses to Johnson &amp; Johnson COVID-19 vaccination in the Amhara region, Ethiopia"],"prefix":"10.1038","volume":"16","author":[{"given":"Alembante","family":"Bazezew","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Berhanu","family":"Woldu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Solomon","family":"Getawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tiruneh","family":"Adane","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fitsumbrhan","family":"Tajebe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Debaka","family":"Belete","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wagaw","family":"Abebe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Girum Meseret","family":"Ayenew","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bewuketu Belete","family":"Alemu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mulugeta Ayalew","family":"yimer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abebaw","family":"Worede","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melak","family":"Aynalem","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,3,16]]},"reference":[{"key":"42484_CR1","doi-asserted-by":"publisher","first-page":"104502","DOI":"10.1016\/j.meegid.2020.104502","volume":"85","author":"N Kirtipal","year":"2020","unstructured":"Kirtipal, N., Bharadwaj, S. & Kang, S. G. From SARS to SARS-CoV-2, insights on structure, pathogenicity and immunity aspects of pandemic human coronaviruses. Infect. Genet. Evol. 85, 104502 (2020).","journal-title":"Infect. Genet. Evol."},{"issue":"1147","key":"42484_CR2","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1136\/postgradmedj-2020-138577","volume":"97","author":"A Parasher","year":"2021","unstructured":"Parasher, A. COVID-19: Current understanding of its Pathophysiology, Clinical presentation and Treatment. Postgrad. Med. J. 97 (1147), 312\u2013320 (2021).","journal-title":"Postgrad. Med. J."},{"key":"42484_CR3","doi-asserted-by":"crossref","unstructured":"Zhu, N. et al. A novel coronavirus from patients with pneumonia in China, 2019. New England journal of medicine. (2020).","DOI":"10.1056\/NEJMoa2001017"},{"key":"42484_CR4","doi-asserted-by":"publisher","first-page":"138861","DOI":"10.1016\/j.scitotenv.2020.138861","volume":"728","author":"I Ali","year":"2020","unstructured":"Ali, I. & Alharbi, O. M. COVID-19: Disease, management, treatment, and social impact. Sci. Total Environ. 728, 138861 (2020).","journal-title":"Sci. Total Environ."},{"key":"42484_CR5","doi-asserted-by":"publisher","first-page":"108448","DOI":"10.1016\/j.clim.2020.108448","volume":"215","author":"S Felsenstein","year":"2020","unstructured":"Felsenstein, S., Herbert, J. A., McNamara, P. S. & Hedrich, C. M. COVID-19: Immunology and treatment options. Clin. Immunol. 215, 108448 (2020).","journal-title":"Clin. Immunol."},{"key":"42484_CR6","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1016\/j.coi.2021.07.003","volume":"71","author":"D Ndwandwe","year":"2021","unstructured":"Ndwandwe, D. & Wiysonge, C. S. COVID-19 vaccines. Curr. Opin. Immunol. 71, 111\u2013116 (2021).","journal-title":"Curr. Opin. Immunol."},{"issue":"11","key":"42484_CR7","doi-asserted-by":"publisher","first-page":"725","DOI":"10.2217\/fvl-2021-0199","volume":"16","author":"J Sadoff","year":"2021","unstructured":"Sadoff, J., Struyf, F. & Douoguih, M. A plain language summary of how well the single-dose Janssen vaccine works and how safe it is. Future Virol. 16 (11), 725\u2013739 (2021).","journal-title":"Future Virol."},{"key":"42484_CR8","doi-asserted-by":"crossref","unstructured":"Mascellino, M. T., Di Timoteo, F., De Angelis, M. & Oliva, A. Overview of the main anti-SARS-CoV-2 vaccines: mechanism of action, efficacy and safety. Infection and drug resistance. 3459\u20133476. (2021).","DOI":"10.2147\/IDR.S315727"},{"issue":"5","key":"42484_CR9","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1002\/ajh.26488","volume":"97","author":"AJ Kanack","year":"2022","unstructured":"Kanack, A. J. et al. Persistence of Ad26. COV2. S\u2010associated vaccine\u2010induced immune thrombotic thrombocytopenia (VITT) and specific detection of VITT antibodies. Am. J. Hematol. 97 (5), 519\u2013526 (2022).","journal-title":"Am. J. Hematol."},{"issue":"1","key":"42484_CR10","doi-asserted-by":"publisher","first-page":"e73","DOI":"10.1016\/S2352-3026(21)00306-9","volume":"9","author":"FA Klok","year":"2022","unstructured":"Klok, F. A., Pai, M., Huisman, M. V. & Makris, M. Vaccine-induced immune thrombotic thrombocytopenia. Lancet Haematol. 9 (1), e73\u2013e80 (2022).","journal-title":"Lancet Haematol."},{"issue":"12","key":"42484_CR11","doi-asserted-by":"publisher","first-page":"1919","DOI":"10.1038\/s41591-020-1112-0","volume":"26","author":"V Kontis","year":"2020","unstructured":"Kontis, V. et al. Magnitude, demographics and dynamics of the effect of the first wave of the COVID-19 pandemic on all-cause mortality in 21 industrialized countries. Nat. Med. 26 (12), 1919\u20131928 (2020).","journal-title":"Nat. Med."},{"key":"42484_CR12","unstructured":"worldometer COVID-19 pandemic: worldometer; [ (2023). Available from: https:\/\/www.worldometers.info\/"},{"key":"42484_CR13","unstructured":"Hasan, M., Akter, R. & Adon, M. H. Jahan IJJoG, org\/10.47363\/JGHR\/ HRSJ-Dd. A Review on Hematological Abnormalities Related with COVID-19. ;161:2\u201311. (2024)."},{"key":"42484_CR14","doi-asserted-by":"crossref","unstructured":"Aydemir, D. & Ulusu, N. N. J. F. M. People having hematological disorders and hypercoagulability state need extra precautions because of the increased risk of thrombosis after COVID-19 vaccination. ;9:1082611. (2023).","DOI":"10.3389\/fmed.2022.1082611"},{"key":"42484_CR15","doi-asserted-by":"crossref","unstructured":"Tiede, A. et al. Prothrombotic immune thrombocytopenia after COVID-19 vaccination. ;138(4):350\u2013353. (2021).","DOI":"10.1182\/blood.2021011958"},{"key":"42484_CR16","doi-asserted-by":"publisher","first-page":"107602962110401","DOI":"10.1177\/10760296211040110","volume":"27","author":"M Haimei","year":"2021","unstructured":"Haimei, M. Concern about the adverse effects of thrombocytopenia and thrombosis after adenovirus-vectored COVID-19 vaccination. Clin. Appl. Thromb. Hemost. 27, 10760296211040110 (2021).","journal-title":"Clin. Appl. Thromb. Hemost."},{"key":"42484_CR17","doi-asserted-by":"crossref","unstructured":"Mathieu, E. et al. A global database of COVID-19 vaccinations. ;5(7):947\u2013953. (2021).","DOI":"10.1038\/s41562-021-01122-8"},{"key":"42484_CR18","doi-asserted-by":"crossref","unstructured":"Jeon, M., Kim, J., Oh, C. E. & Lee, J-Y. Adverse events following immunization associated with coronavirus disease 2019 vaccination reported in the mobile vaccine adverse events reporting system. J. Korean Med. Sci. ;36(17). (2021).","DOI":"10.3346\/jkms.2021.36.e114"},{"key":"42484_CR19","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1016\/j.ajem.2021.05.054","volume":"49","author":"B Long","year":"2021","unstructured":"Long, B., Bridwell, R. & Gottlieb, M. Thrombosis with thrombocytopenia syndrome associated with COVID-19 vaccines. Am. J. Emerg. Med. 49, 58\u201361 (2021).","journal-title":"Am. J. Emerg. Med."},{"key":"42484_CR20","doi-asserted-by":"crossref","unstructured":"Mingot-Castellano, M. E. et al. del Carmen G\u00f3mez del Castillo Solano M, S\u00e1nchez-Gonz\u00e1lez B, Jim\u00e9nez-B\u00e1rcenas R,. COVID-19 vaccines and autoimmune hematologic disorders. ;10(6):961. (2022).","DOI":"10.3390\/vaccines10060961"},{"key":"42484_CR21","doi-asserted-by":"crossref","unstructured":"Al-Ali, D. et al. Cardiovascular and haematological events post COVID\u201019 vaccination: A systematic review. ;26(3):636\u2013653. (2022).","DOI":"10.1111\/jcmm.17137"},{"key":"42484_CR22","doi-asserted-by":"crossref","unstructured":"Ayalew, D., Tesfaye, K., Mamo, G., Yitaferu, B. & Bayu, W. Outlook of future climate in northwestern Ethiopia. (2012).","DOI":"10.4236\/as.2012.34074"},{"issue":"1","key":"42484_CR23","doi-asserted-by":"publisher","first-page":"28481","DOI":"10.1038\/s41598-024-76540-5","volume":"14","author":"GG Gebrerufael","year":"2024","unstructured":"Gebrerufael, G. G., Welegebrial, B. G., Berhie, K. A., Hagos, B. T. & Teklezgi, M. G. Prevalence of diarrheal and its associated factors among children aged under-five years in Amhara Regional State, Ethiopia: a cross-sectional study. Sci. Rep. 14 (1), 28481 (2024).","journal-title":"Sci. Rep."},{"key":"42484_CR24","unstructured":"Zaidi, S. R. H. & Rout, P. Interpretation of blood clotting studies and values (PT, PTT, aPTT, INR, anti-factor Xa, D-dimer) (StatPearls Publishing, 2025)."},{"issue":"7","key":"42484_CR25","first-page":"765","volume":"23","author":"B Enawgaw","year":"2018","unstructured":"Enawgaw, B. et al. Haematological and immunological reference intervals for adult population in the state of Amhara. Ethiopia 23 (7), 765\u2013773 (2018).","journal-title":"Ethiopia"},{"issue":"2","key":"42484_CR26","doi-asserted-by":"publisher","first-page":"43","DOI":"10.20982\/tqmp.03.2.p043","volume":"3","author":"CW VanVoorhis","year":"2007","unstructured":"VanVoorhis, C. W. & Morgan, B. L. Understanding power and rules of thumb for determining sample sizes. Tutorials Quant. methods Psychol. 3 (2), 43\u201350 (2007).","journal-title":"Tutorials Quant. methods Psychol."},{"key":"42484_CR27","doi-asserted-by":"crossref","unstructured":"Tarawneh, O. & Tarawneh, H. J. A. Immune thrombocytopenia in a 22-year\u2010old post Covid\u201019 vaccine. ;96(5):E133. (2021).","DOI":"10.1002\/ajh.26106"},{"key":"42484_CR28","unstructured":"Babiker, N. E. et al. Coagulation Parameters Among Sudanese Individuals Vaccinated with Johnson and Johnson Vaccine at Khartoum State, 2023;11(1):9\u201316. (2022)."},{"issue":"9","key":"42484_CR29","doi-asserted-by":"publisher","first-page":"2119","DOI":"10.1007\/s11095-022-03323-w","volume":"39","author":"S Upreti","year":"2022","unstructured":"Upreti, S. & Samant, M. A Review on Immunological Responses to SARS-CoV-2 and Various COVID-19 Vaccine Regimens. Pharm. Res. 39 (9), 2119\u20132134 (2022).","journal-title":"Pharm. Res."},{"key":"42484_CR30","doi-asserted-by":"publisher","first-page":"127342","DOI":"10.1016\/j.vaccine.2025.127342","volume":"61","author":"S Mohammadi","year":"2025","unstructured":"Mohammadi, S. et al. COVID-19 vaccine safety studies among special populations: A systematic review and meta-analysis of 120 observational studies and randomized clinical trials. Vaccine 61, 127342 (2025).","journal-title":"Vaccine"},{"key":"42484_CR31","doi-asserted-by":"crossref","unstructured":"Scully, M. et al. Pathologic antibodies to platelet factor 4 after ChAdOx1 nCoV-19 vaccination. ;384(23):2202\u20132211. (2021).","DOI":"10.1056\/NEJMoa2105385"},{"key":"42484_CR32","doi-asserted-by":"crossref","unstructured":"Pavord, S. et al. Clinical features of vaccine-induced immune thrombocytopenia and thrombosis. ;385(18):1680\u20131689. (2021).","DOI":"10.1056\/NEJMoa2109908"},{"issue":"20","key":"42484_CR33","doi-asserted-by":"publisher","first-page":"1964","DOI":"10.1056\/NEJMc2105869","volume":"384","author":"K-L Muir","year":"2021","unstructured":"Muir, K-L., Kallam, A., Koepsell, S. A. & Gundabolu, K. Thrombotic thrombocytopenia after Ad26. COV2. S vaccination. N. Engl. J. Med. 384 (20), 1964\u20131965 (2021).","journal-title":"N. Engl. J. Med."},{"key":"42484_CR34","doi-asserted-by":"crossref","unstructured":"Ostrowski, S. R. et al. Inflammation and platelet activation after COVID-19 vaccines-possible mechanisms behind vaccine-induced immune thrombocytopenia and thrombosis. ;12:779453. (2021).","DOI":"10.3389\/fimmu.2021.779453"},{"key":"42484_CR35","doi-asserted-by":"crossref","unstructured":"See, I. et al. US case reports of cerebral venous sinus thrombosis with thrombocytopenia after Ad26. COV2. S vaccination, March 2 to April 21, 2021;325(24):2448-56. (2021).","DOI":"10.1001\/jama.2021.7517"},{"key":"42484_CR36","doi-asserted-by":"crossref","unstructured":"Algaissi, A. et al. Evaluation of hematological parameters and thrombocytopenia following Pfizer-BioNTech (BNT162b2) SARS-CoV-2 vaccination. ;43(6):567. (2022).","DOI":"10.15537\/smj.2022.43.6.20220135"},{"issue":"7","key":"42484_CR37","doi-asserted-by":"publisher","first-page":"1813","DOI":"10.1111\/jth.15352","volume":"19","author":"IH S\u00f8rvoll","year":"2021","unstructured":"S\u00f8rvoll, I. H. et al. An observational study to identify the prevalence of thrombocytopenia and anti-PF4\/polyanion antibodies in Norwegian health care workers after COVID-19 vaccination. J. Thromb. haemostasis: JTH. 19 (7), 1813\u20131818 (2021).","journal-title":"J. Thromb. haemostasis: JTH"},{"key":"42484_CR38","doi-asserted-by":"crossref","unstructured":"Chaudhary, M. H. et al. Autoimmune Hemolytic Anemia Secondary to COVID-19 Vaccine: A Case Report. ;15(10). (2023).","DOI":"10.7759\/cureus.46678"},{"key":"42484_CR39","doi-asserted-by":"crossref","unstructured":"Brito, S. et al. A case of autoimmune hemolytic anemia following COVID-19 messenger ribonucleic acid vaccination. ;13(5). (2021).","DOI":"10.7759\/cureus.15035"},{"issue":"6","key":"42484_CR40","doi-asserted-by":"publisher","first-page":"3330","DOI":"10.1097\/MS9.0000000000002064","volume":"86","author":"QA Khan","year":"2024","unstructured":"Khan, Q. A. et al. Hematological parameters to predict post-COVID-19 immune response among vaccinated and nonvaccinated individuals: a retrospective cross-sectional study. Ann. Med. Surg. (Lond). 86 (6), 3330\u20133336 (2024).","journal-title":"Ann. Med. Surg. (Lond)"},{"issue":"1","key":"42484_CR41","first-page":"382","volume":"2018","author":"A Hill","year":"2018","unstructured":"Hill, A., Hill, Q. A. J. H. & the American Society of Hematology Education Program Book. Autoimmune hemolytic anemia ;2018(1):382\u2013389. (2018).","journal-title":"Autoimmune hemolytic anemia"},{"key":"42484_CR42","doi-asserted-by":"crossref","unstructured":"Chen, Y. et al. New-onset autoimmune phenomena post\u2010COVID\u201019 vaccination. ;165(4):386\u2013401. (2022).","DOI":"10.1111\/imm.13443"},{"key":"42484_CR43","doi-asserted-by":"crossref","unstructured":"Vadal\u00e0, M., Poddighe, D., Laurino, C. & Palmieri, B. J. E. J. Vaccination and autoimmune diseases: is prevention of adverse health effects on the horizon? ;8:295\u2013311. (2017).","DOI":"10.1007\/s13167-017-0101-y"},{"issue":"1","key":"42484_CR44","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1038\/s41421-021-00329-3","volume":"7","author":"J Liu","year":"2021","unstructured":"Liu, J. et al. Comprehensive investigations revealed consistent pathophysiological alterations after vaccination with COVID-19 vaccines. Cell. Discovery. 7 (1), 99 (2021).","journal-title":"Cell. Discovery"},{"issue":"4","key":"42484_CR45","first-page":"116","volume":"5","author":"H Abdelrhman","year":"2022","unstructured":"Abdelrhman, H., Abdelgadir, A. & Hosham, A. The effect of Covid-19 Astra Zeneca vaccines on some coagulation profile (PT, APTT) among Sudanese two doses vaccinated. Hematol. Blood Disord. 5 (4), 116 (2022).","journal-title":"Hematol. Blood Disord"},{"issue":"4","key":"42484_CR46","doi-asserted-by":"publisher","first-page":"798","DOI":"10.1007\/s11239-021-02626-w","volume":"53","author":"MH Elberry","year":"2022","unstructured":"Elberry, M. H. et al. A systematic review of vaccine-induced thrombotic thrombocytopenia in individuals who received COVID-19 adenoviral-vector-based vaccines. J. Thromb. Thrombolysis. 53 (4), 798\u2013823 (2022).","journal-title":"J. Thromb. Thrombolysis"},{"key":"42484_CR47","doi-asserted-by":"crossref","unstructured":"Greinacher, A. et al. Thrombotic thrombocytopenia after ChAdOx1 nCov-19 vaccination. ;384(22):2092\u20132101. (2021).","DOI":"10.1056\/NEJMoa2104840"},{"key":"42484_CR48","doi-asserted-by":"crossref","unstructured":"Purnamasidhi, C. A. W., Adiputra, I. K. H., Purnama, G. V., Suteja, R. C. & Weisnawa, I. G. P. J. A. P. J. T. M. Vaccine induced thrombotic thrombocytopenia: Coagulation after administration of COVID-19 vaccine. ;14(11):477\u2013478. (2021).","DOI":"10.4103\/1995-7645.331254"},{"issue":"1","key":"42484_CR49","first-page":"975","volume":"7","author":"AAH Nafady","year":"2024","unstructured":"Nafady, A. A. H. & Sayed, R. F. Assessment of Coagulation Profile in Adults Vaccinated Against SARS-CoV\u20102 (COVID-19) in Qena Governorate. SVU-International J. Med. Sci. 7 (1), 975\u2013985 (2024).","journal-title":"SVU-International J. Med. Sci."},{"key":"42484_CR50","doi-asserted-by":"publisher","first-page":"1122651","DOI":"10.3389\/fimmu.2023.1122651","volume":"14","author":"Q Xu","year":"2023","unstructured":"Xu, Q. et al. Effect of an inactivated coronavirus disease 2019 vaccine, CoronaVac, on blood coagulation and glucose: a randomized, controlled, open-label phase IV clinical trial. Front. Immunol. 14, 1122651 (2023).","journal-title":"Front. Immunol."},{"issue":"4","key":"42484_CR51","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1007\/s12291-021-00968-z","volume":"36","author":"RJ Kaur","year":"2021","unstructured":"Kaur, R. J. et al. Adverse events reported from COVID-19 vaccine trials: a systematic review. Indian J. Clin. Biochem. 36 (4), 427\u2013439 (2021).","journal-title":"Indian J. Clin. Biochem."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-42484-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-42484-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-42484-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T22:27:06Z","timestamp":1777415226000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-42484-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,16]]},"references-count":51,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["42484"],"URL":"https:\/\/doi.org\/10.1038\/s41598-026-42484-1","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,16]]},"assertion":[{"value":"30 December 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 February 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 March 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests. We hereby declare that this manuscript is original and has not been submitted to or published in any other journal.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interest"}},{"value":"The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. The protocol received approval from the Research and Ethics Committee of the School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Ethiopia (Reference No: SBMLS\/513). Support letters were obtained from the Amhara National Regional State Public Health Institute, and administrative approvals were secured from all participating hospitals, including the University of Gondar Comprehensive Specialized Hospital, Bahir Dar Felege Hiwot Comprehensive Specialized Hospital, Debre Markos Comprehensive Specialized Hospital, Dessie Comprehensive Specialized Hospital, and Debre Birhan Comprehensive Specialized Hospital. Prior to enrollment, all participants were provided with detailed information about the study objectives, procedures, potential benefits, and risks, and written informed consent was obtained. Individuals who had abnormal coagulation or haematological indicators were referred to the appropriate facilities for clinical assessment and treatment.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}],"article-number":"13649"}}