Relationship between splenomegaly and hematologic findings in patients with hepatosplenic schistosomiasis

Abstract

BackgroundSchistosomiasis is a tropical disease. Patients who develop hepatosplenic schistosomiasis have clinical findings including periportal fibrosis, portal hypertension, cytopenia, splenomegaly and gastrointestinal hemorrhage. ObjectiveThe aim of this study was to analyze the hemostatic and hematologic findings of patients with schistosomiasis and correlate these to the size of the spleen. MethodsFifty-five adults with hepatosplenic schistosomiasis and 30 healthy subjects were selected through a history of contact with contaminated water, physical examination and ultrasound characteristics such as periportal fibrosis and splenomegaly in the Gastroenterology Service of the Universidade Federal de Pernambuco. Blood samples were collected to determine liver function, blood counts, prothrombin (international normalized ratio), partial thromboplastin time and fibrinogen and D-Dimer levels using the Pentra 120 hematological analyzer (HORIBA/ABX), Density Plus (test photo-optical Trinity Biotech, Ireland) and COBAS analyzer 6000 (Roche). Furthermore, the longitudinal size of the spleen was measured by ultrasound (Acuson X analyzer 150, Siemens). The Student t-test, the Fisher test and Pearson's correlation were used to analyze the results with statistical significance being set for a p-value < 0.05. ResultsThe mean age was higher for the Study Group than for the Control Group (54 ± 13.9 vs. 38 ± 12.7 years). The average longitudinal diameter of the spleen was 16.9 cm (Range: 12.3-26.3 cm). Anemia is a common finding in patients with schistosomiasis (36.3%). The mean platelet and leukocyte counts of patients were lower than for the Control Group (p-value < 0.001). Moreover, the international normalized ratio (1.42 vs. 1.04), partial thromboplastin time (37.9 vs. 30.5 seconds) and D-Dimer concentration (393 vs. 86.5 ng/mL) were higher for the Study Group compared to the Control Group. ConclusionThis study suggests that hematological and hemostatic abnormalities are associated with splenomegaly, hypersplenism and portal hypertension.

Correlation between the values of circulating blood elements with the size of spleen in the presence of schistosomal splenomegaly

“…Among the cytopenias observed, plateletopenia was the most common, followed by leukopenia and anemia. These findings were also reported in other studies [24][25][26][27][28][29][30] .…”

New index for the diagnosis of liver fibrosis in Schistosomiasis mansoni

“…Morais et al (25) showed that this enzyme as an accurate marker to predict moderate and severe fibrosis in patients with hepatitis C. With regard to schistosomiasis, a study described by Leite et al (18) with 55 hepatosplenic patients, they found the prevalence of advanced fibrosis in 54.5% of patients and compared them to healthy individuals, the levels of AP presented significantly elevated (P<0.0001). Other studies with hepatosplenic patients, they showed a significant increase in serum levels of AP in relation to control groups (19,20) . In schistosomiasis, the changes of the intrahepatic biliary tree, either by ductal injuries caused by ovular reactions or arising from of PPF, could be the anatomical substrate for the increase of this enzyme (3,34) .…”

The chronic enteropathogenic disease schistosomiasis

“…7,29 Severe schistosome-induced hepatic fibrosis causes portal vein obliteration leading to the development of portal hypertension, and lethal complications of the hepatosplenic form of the disease include pulmonary hypertension, 30,31 glomerulopathy, 32,33 splenomegaly, and thrombocytopenia. 34 Despite the general mechanism of granuloma formation leading to hepatic fibrosis in schistosomiasis, studies have shown some peculiarities regarding this pathogenesis among schistosome species. For instance, in a study involving mouse models, tissue studies were done to shed light on the characteristics of granulomas caused by S. mekongi compared with S. japonicuminduced granulomas.…”