Estimation of prothrombin in liver disease

Area of Science:

• Hepatology
• Hematology
• Clinical Chemistry

Background:

• Prothrombin time assays are crucial for evaluating hemostatic balance.
• Different assay methods (one-stage and two-stage) can yield variable results, particularly in liver disease.
• Understanding these variations is important for clinical decision-making.

Purpose of the Study:

• To compare prothrombin (coagulation factor II) and progressive antithrombin levels using one-stage and two-stage assays in patients with cirrhosis and acute hepatitis.
• To evaluate the correlation of these measurements with indices of protein synthesis.
• To determine the most appropriate prothrombin assay for assessing hemostatic function in liver failure.

Main Methods:

• Plasma samples from 47 cirrhosis patients and 27 acute hepatitis patients were analyzed.
• Prothrombin was measured using both one-stage and two-stage methods.
• Progressive antithrombin levels were also determined.

Main Results:

• In cirrhosis, two-stage prothrombin assays yielded higher values than one-stage assays, often within the normal range and not correlated with protein synthesis. This is likely due to antithrombin interference.
• In acute hepatitis, one-stage assays gave higher prothrombin values than two-stage assays, correlating better with protein synthesis.
• Progressive antithrombin was depressed in cirrhosis patients.

Conclusions:

• The choice of prothrombin assay method significantly impacts results in liver disease.
• The one-stage prothrombin assay is suggested for evaluating hemostatic balance in liver failure patients prior to procedures like liver biopsy or surgery.
• Assay interference by antithrombin can lead to misleading prothrombin level interpretations in certain liver conditions.