Splenectomy Improves Hemostatic and Liver Functions in Hepatosplenic Schistosomiasis Mansoni

Abstract

BackgroundSchistosomiasis mansoni is a chronic liver disease, in which some patients (5–10%) progress to the most severe form, hepatosplenic schistosomiasis. This form is associated with portal hypertension and splenomegaly, and often episodes of gastrointestinal bleeding, even with liver function preserved. Splenectomy is a validated procedure to reduce portal hypertension following digestive bleeding. Here, we evaluate beneficial effects of splenectomy on blood coagulation factors and liver function tests in hepatosplenic schistosomiasis mansoni compared to non-operated patients.Methodology/Principal FindingsForty-five patients who had undergone splenectomy surgery were assessed by laboratory analyses and ultrasound examination and compared to a non-operated group (n = 55). Blood samples were obtained for liver function tests, platelet count and prothrombin time. Coagulation factors (II, VII, VIII, IX and X), protein C and antithrombin IIa, plasminogen activator inhibitor-1 were measured by routine photometric, chromogenic or enzyme-linked immunosorbent assays, while hyperfibrinolysis was defined by plasminogen activator inhibitor-1 levels. Both groups had similar age, gender and pattern of periportal fibrosis. Splenectomized patients showed significant reductions in portal vein diameter, alkaline phosphatase and bilirubin levels compared to non-operated patients, while for coagulation factors there were significant improvement in prothrombin, partial thromboplastin times and higher levels of factor VII, VIII, IX, X, protein C and plasminogen activator inhibitor-1.Conclusion/SignificanceThis study shows that the decrease of flow pressure in portal circulation after splenectomy restores the capacity of hepatocyte synthesis, especially on the factor VII and protein C levels, and these findings suggest that portal hypertension in patients with hepatosplenic schistosomiasis influences liver functioning and the blood coagulation status.

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) .…”

Improved survival following splenectomy combined with curative treatments for hepatocellular carcinoma in Child B patients: A propensity score matching study

“…Several studies have found that splenectomy could improve liver function among patients with Child grade B liver function. 22,24,37 In our research, hepatic function in most patients was ameliorated 1 year after surgery, especially among patients who underwent splenectomy. One possible factor contributes this effect is that these patients received additional medical treatments or changed their lifestyles, such as antiviral therapy, smoking cessation, and alcohol withdrawal.…”

“…21 Several studies reported that patients with Child B liver function benefited from splenectomy, and liver function in most patients improved significantly 1 year after splenectomy. [22][23][24] Other studies also indicated that splenectomy combined with hepatectomy could extend disease-free survival and overall survival. 12,15,25 However, these studies had some limitations, with either small sample sizes or heterogeneous populations.…”

Splenectomy in non-traumatic diseases

“…Complications due to splenomegaly are mainly related to mechanical symptoms (pain, early satiety, diarrhoea and distension), portal hypertension, and splenic sequestration with exacerbation of previous cytopenias. [38][39][40] The use of ruxolitinib has contributed to reduce splenectomy for treatment of myelofibrosis. However, in thrombocytopenia (<20×103/uL) or cytopenias associated with use of ruxolitinib, splenectomy is indicated and has proven beneficial.…”