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Early liver dysfunction in schistosomiasis

L Camacho-Lobato1, D R Borges

  • 1Department of Medicine, Universidade Federal de São Paulo, Brazil.

Journal of Hepatology
|August 29, 1998
PubMed
Summary
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Schistosomiasis impairs liver function and protein synthesis early, contrary to previous beliefs. This study found reduced clotting factors, not consumption coagulopathy, in patients with chronic schistosomiasis.

Area of Science:

  • Hepatology and Infectious Diseases
  • Coagulation and Hemostasis
  • Parasitology

Background:

  • Schistosomiasis is often thought to cause liver dysfunction late in its course.
  • Prolonged prothrombin time in schistosomiasis is attributed to subclinical consumption coagulopathy, as albumin levels remain normal.
  • The exact role of liver function and Schistosoma mansoni in compromised hemostasis requires further investigation.

Purpose of the Study:

  • To evaluate the role of Schistosoma mansoni infection and liver function in hemostatic abnormalities.
  • To investigate the genesis of compromised hemostasis tests in chronic "pure" schistosomiasis patients.

Main Methods:

  • Studied 25 adults with chronic "pure" schistosomiasis (hepatointestinal and compensated hepatosplenic forms) and 10 controls.

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  • Excluded participants with alcoholism, viral hepatitis, malnutrition, or anticoagulant use.
  • Assessed liver function, coagulation factors (transthyretin, prothrombin, antithrombin, protein C), and coagulation activation markers (F1+2, ATM, t-PA).

    • Main Results:

    • Patients with compensated hepatosplenic schistosomiasis showed decreased plasma levels of transthyretin, protein C, prothrombin, and antithrombin.
    • Albuminaemia, F1+2, and ATM plasma levels remained normal.
    • Tissue plasminogen activator (t-PA) activity was significantly increased in these patients.

    Conclusions:

    • Findings suggest impaired liver clearance and protein synthesis capacity, rather than consumption coagulopathy, contribute to hemostatic changes.
    • Liver function alterations appear to be an early event in the course of schistosomiasis.
    • These results challenge the traditional view of liver dysfunction occurring late in schistosomiasis.