PLoS Neglected Tropical Diseases (Jan 2013)

Hemostatic dysfunction is increased in patients with hepatosplenic schistosomiasis mansoni and advanced periportal fibrosis.

  • Luiz Arthur Calheiros Leite,
  • Adenor Almeida Pimenta Filho,
  • Caíque Silveira Martins da Fonseca,
  • Bianka Santana dos Santos,
  • Rita de Cássia dos Santos Ferreira,
  • Silvia Maria Lucena Montenegro,
  • Edmundo Pessoa Lopes,
  • Ana Lúcia Coutinho Domingues,
  • James Stuart Owen,
  • Vera Lúcia de Menezes Lima

DOI
https://doi.org/10.1371/journal.pntd.0002314
Journal volume & issue
Vol. 7, no. 7
p. e2314

Abstract

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BackgroundSchistosomiasis mansoni is an endemic parasitic disease and a public health problem in Northeast Brazil. In some patients, hepatic abnormalities lead to periportal fibrosis and result in the most severe clinical form, hepatosplenic schistosomiasis. This study aimed to evaluate whether abnormal blood coagulation and liver function tests in patients with hepatosplenic schistosomiasis (n = 55) correlate with the severity of their periportal fibrosis.Methodology/principal findingsBlood samples were used for liver function tests, hemogram and prothrombin time (International Normalized Ratio, INR). The blood coagulation factors (II, VII, VIII, IX and X), protein C and antithrombin IIa (ATIIa), plasminogen activator inhibitor 1 (PAI-1) and D-dimer were measured by photometry or enzyme linked immunosorbent assay. Hyperfibrinolysis was defined on the basis of PAI-1 levels and a D-dimer concentration greater than a standard cut-off of 483 ng/mL. Standard liver function tests were all abnormal in the patient group compared to healthy controls (n = 29), including raised serum transaminases (pConclusion/significanceThis study confirms that hemostatic abnormalities are associated with reduced liver function and increased liver fibrosis. Of note was the finding that a quarter of patients with hepatosplenic schistosomiasis and advanced periportal fibrosis have hyperfibrinolysis, as judged by excessive levels of D-dimer, which may predispose them to gastrointestinal bleeding.