Abstract
BackgroundSchistosomiasis 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.Methodology/Principal FindingsForty-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.Conclusion/SignificanceThis 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.
Highlights
Schistosomiasis causes one of the most prevalent liver diseases, affecting more than 200 million people in over 74 different countries and is a major public health problem in the Northeast region of Brazil [1,2]
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
10% of patients infected by Schistosoma mansoni progress to the most severe form, hepatosplenic (HS) schistosomiasis, which is characterized by periportal fibrosis (PPF), obstruction by eggs of intrahepatic veins, presinusoidal portal hypertension, splenomegaly, hemodynamic and lipid abnormalities, frequently resulting in upper digestive bleeding [3,4,5]
Summary
Schistosomiasis causes one of the most prevalent liver diseases, affecting more than 200 million people in over 74 different countries and is a major public health problem in the Northeast region of Brazil [1,2]. 10% of patients infected by Schistosoma mansoni progress to the most severe form, hepatosplenic (HS) schistosomiasis, which is characterized by periportal fibrosis (PPF), obstruction by eggs of intrahepatic veins, presinusoidal portal hypertension, splenomegaly, hemodynamic and lipid abnormalities, frequently resulting in upper digestive bleeding [3,4,5]. 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. We evaluate beneficial effects of splenectomy on blood coagulation factors and liver function tests in hepatosplenic schistosomiasis mansoni compared to non-operated patients
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