Splenectomy Improves Hemostatic and Liver Functions in Hepatosplenic Schistosomiasis Mansoni.
BACKGROUND
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.


RESULTS
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.


CONCLUSIONS
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.
Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil; Departamento de Biofísica e Radiobiologia, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
Luiz Arthur Calheiros
LA
Leite
Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
Adenor Almeida
AA
Pimenta Filho
Departamento de Medicina Tropical, Centro de Ciências da Saúde, Universidade Federal de Pernambuco, Recife, Brazil.
Rita de Cássia dos Santos
Rde C
Ferreira
Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
Caíque Silveira Martins
CS
da Fonseca
Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
Bianka Santana
BS
dos Santos
Departamento de Imunologia, Centro de Pesquisa Aggeu Magalhães (CPqAM)/FIOCRUZ-Recife, Pernambuco, Brazil.
Silvia Maria Lucena
SM
Montenegro
Departamento de Medicina Clínica, Centro de Ciências da Saúde, Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
Edmundo Pessoa de Almeida
EP
Lopes
Departamento de Medicina Clínica, Centro de Ciências da Saúde, Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
Ana Lúcia Coutinho
AL
Domingues
Institute of Liver and Digestive Health, Division of Medicine, University College London Medical School, Royal Free Campus, London, United Kingdom.
James Stuart
JS
Owen
Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
Vera Lucia de Menezes
VL
Lima
D000469:Alkaline Phosphatase / Q000097:blood; D001663:Bilirubin / Q000097:blood; D005260:Female; D006487:Hemostasis; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D017395:Plasminogen Activator Inhibitor 1 / Q000378:metabolism; D011486:Protein C / Q000378:metabolism; D011516:Prothrombin / Q000378:metabolism; D012555:Schistosomiasis mansoni / Q000601:surgery*; D013156:Splenectomy; D014463:Ultrasonography
D017395:Plasminogen Activator Inhibitor 1; D011486:Protein C; D011516:Prothrombin; D000469:Alkaline Phosphatase; D001663:Bilirubin