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Hyperfibrinolysis in hepatosplenic schistosomiasis
N E el-Bassiouni1, A E el Bassiouny, H R el-Khayat
1Department of Haematology, Theodor Bilharz Research Institute, Imbaba, Giza, Egypt.
Journal of Clinical Pathology
|December 1, 1996
Summary
Accelerated fibrinolysis in hepatosplenic schistosomiasis is linked to reduced antifibrinolytic factors, particularly plasminogen activator inhibitor-1 (PAI-1). Low PAI-1 levels may indicate a risk of bleeding in decompensated patients.
Area of Science:
- Hematology
- Parasitology
- Hepatology
Background:
- Hepatosplenic schistosomiasis is endemic in Egypt, affecting liver and spleen function.
- Altered hemostasis, including accelerated fibrinolysis, is observed in patients with this condition.
- Understanding the mechanisms of hyperfibrinolysis is crucial for managing complications.
Purpose of the Study:
- To investigate the nature of accelerated fibrinolysis in patients with hepatosplenic schistosomiasis.
- To evaluate the roles of profibrinolytic and antifibrinolytic factors in disease progression.
- To identify potential indicators of hemostatic imbalance.
Main Methods:
- Photometric analysis of plasminogen (Plg), plasminogen activators (PA), alpha 2-antiplasmin (alpha 2-AP), and plasminogen activator inhibitor-1 (PAI-1).
- Quantitative measurement of plasma concentrations for tissue t-PA, t-PA-PAI-1 complex, alpha 2-antiplasmin-plasmin complex (alpha 2-APP), fibrinogen degradation products (FbDP), D-dimers (D-D), thrombin-antithrombin complex (TAT), and prothrombin fragment (F 1 + 2).
- Assessment of hepatic insufficiency using the Child-Pugh classification.
Main Results:
- Progressive liver dysfunction correlated with disease severity, showing simultaneous defects in profibrinolytic (decreased Plg, increased PA and t-PA) and antifibrinolytic (decreased alpha 2-AP and PAI-1) factors.
- Antifibrinolytic defects, particularly reduced PAI-1, were more prominent, leading to increased plasmin generation (higher alpha 2-APP) and enhanced fibrinolysis (elevated FbDP and D-dimer).
- Elevated FbDP, D-D, TAT, and F 1 + 2 confirmed the secondary nature of fibrinolysis.
Conclusions:
- Reduced PAI-1 availability to neutralize tissue plasminogen activator (t-PA) is a critical factor in hyperfibrinolysis in hepatosplenic schistosomiasis.
- A pronounced decrease in plasma PAI-1 concentration may serve as a warning indicator of hemostatic imbalance.
- This imbalance poses a high risk of variceal bleeding in decompensated schistosomal patients.