Splenectomy Improves Hemostatic and Liver Functions in Hepatosplenic Schistosomiasis Mansoni

Schistosomiasis mansoni is a chronic liver disease, in which some patients (5-10%) progress to the most severe form, hepatosplenic schistosomiasis. This form is associated with portal hypertension and splenomegaly, and often episodes of gastrointestinal bleeding, even with liver function preserved....

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Published in:PloS one 2015-08, Vol.10 (8), p.e0135370-e0135370
Main Authors: Leite, Luiz Arthur Calheiros, Pimenta Filho, Adenor Almeida, Ferreira, Rita de Cássia dos Santos, da Fonseca, Caíque Silveira Martins, dos Santos, Bianka Santana, Montenegro, Silvia Maria Lucena, Lopes, Edmundo Pessoa de Almeida, Domingues, Ana Lúcia Coutinho, Owen, James Stuart, Lima, Vera Lucia de Menezes
Format: Article
Language:English
Subjects:
Alkaline phosphatase
Alkaline Phosphatase - blood
Antithrombin
Bilirubin
Bilirubin - blood
Bleeding
Blood
Blood coagulation
Cholesterol
Coagulation
Coagulation factors
Eggs
Enzymes
Female
Fibrosis
Hemostasis
Hepatitis
Hospitals
Humans
Hypertension
Immunoassays
Inhibitors
Liver
Liver - diagnostic imaging
Liver - metabolism
Liver - physiology
Liver diseases
Male
Middle Aged
Patients
Phosphatase
Photometry
Plasminogen Activator Inhibitor 1 - metabolism
Plasminogen activator inhibitors
Portal vein
Protein C
Protein C - metabolism
Proteins
Prothrombin
Prothrombin - metabolism
Schistosoma mansoni
Schistosomiasis
Schistosomiasis mansoni - surgery
Splenectomy
Splenomegaly
Surgery
Thromboplastin
Thrombosis
Tropical diseases
Ultrasonic imaging
Ultrasonography
Ultrasound
Veins & arteries
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Summary:Schistosomiasis mansoni is a chronic liver disease, in which some patients (5-10%) progress to the most severe form, hepatosplenic schistosomiasis. This form is associated with portal hypertension and splenomegaly, and often episodes of gastrointestinal bleeding, even with liver function preserved. Splenectomy is a validated procedure to reduce portal hypertension following digestive bleeding. Here, we evaluate beneficial effects of splenectomy on blood coagulation factors and liver function tests in hepatosplenic schistosomiasis mansoni compared to non-operated patients. Forty-five patients who had undergone splenectomy surgery were assessed by laboratory analyses and ultrasound examination and compared to a non-operated group (n = 55). Blood samples were obtained for liver function tests, platelet count and prothrombin time. Coagulation factors (II, VII, VIII, IX and X), protein C and antithrombin IIa, plasminogen activator inhibitor-1 were measured by routine photometric, chromogenic or enzyme-linked immunosorbent assays, while hyperfibrinolysis was defined by plasminogen activator inhibitor-1 levels. Both groups had similar age, gender and pattern of periportal fibrosis. Splenectomized patients showed significant reductions in portal vein diameter, alkaline phosphatase and bilirubin levels compared to non-operated patients, while for coagulation factors there were significant improvement in prothrombin, partial thromboplastin times and higher levels of factor VII, VIII, IX, X, protein C and plasminogen activator inhibitor-1. This study shows that the decrease of flow pressure in portal circulation after splenectomy restores the capacity of hepatocyte synthesis, especially on the factor VII and protein C levels, and these findings suggest that portal hypertension in patients with hepatosplenic schistosomiasis influences liver functioning and the blood coagulation status.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0135370