Hypoprothrombinemia in the Compensated Form of Hepatosplenic

C o a g u l a t i o n a b n o r m a l i t y is f requent l y obse rved i n s c h i s t o s o m i a s i s p a t i e n t s bu t i ts p a t h o p h y s i o l o g y h a s no t been e s t a b l i s h e d . We m e a s u r e d , by i m m u n o d i f f u s i o n . the p r o t h r o m b i n a n t i g e n c o n c e n t r a t i o n i n 56 i n d i v i d u a l s ; of these 19 w i th d e m o n s t ra ted c o m p e n s a t e d fo rm of h e p a t o s p l e n i c s c h i s t o s o m i a s i s , 17 w i th c i r r hos i s a n d 20 were con t ro l s u b j e c t s . T r a n s a m i n a s e s , a l b u m i n , t r a n s t h y r e t i n , p r o t h r o m b i n t ime, a n t i t h r o m b i n I I I , fac to r V I I , a n d f i b r i nogen were a lso e v a l u a t e d . A l l p a r a m e t e r s were a l te red in the c i r rho t i c g r o u p b u t on ly a l b u m i n , p r o t h r o m b i n a n d a n t i t h r o m b i n I I I leve ls were a l te red i n the s c h i s t o s o m i a s i s g roup . N i n e t y pe rcen t of the p a t i e n t s w i t h c i r r hos i s a n d s i x t y pe rcen t of the pa t i en t s w i th s c h i s t o s o m i a s i s h a d a b n o r m a l p l a s m a leve l s of a l b u m i n , t r a n s t h y r e t i n , p r o t h r o m b i n a n t i g e n , and /o r a n t i t h r o m b i n I I I ; a n i m p a i r e d h e p a t i c s y n t h e s i s w a s respons ib l e for these resu l ts . C o n v e r s e l y for ty pe rcen t of the s c h i s t o s o m i a s i s p a t i e n t s w i t h n o r m a l p l a s m a c o n c e n t r a t i o n s of b o t h a l b u m i n a n d t r a n s t h y r e t i n h a d dec reased m e a n p l a s m a leve ls of b o t h p r o t h r o m b i n a n d a n t i t h r o m b i n I I I . T h e s e resu l t s s u g g e s t t ha t e i ther p ro th r o m b i n a n d a n t i t h r o m b i n I I I are m o r e sens i t i ve m a r k e r s of i m p a i r e d hepa t i c s y n t h e s i s i n s c h i s t o s o m i a s i s t h a n are l e v e l s of a l b u m i n a n d t r a n s t h y r e t i n c o m b i n e d , or a low g r a d e c h r o n i c c o n s u m p t i o n of c l o t t i ng p ro te ins a lso o c c u r s . C o n s i d e r i n g the la t te r h y p o t h e s i s i t i s p o s s i b l e t h a t the t h r o m b i n fo rmed w o u l d be i n h i b i t e d b y a n t i t h r o m b i n I I I w i t h the c o m p l e x e d t h r o m b i n a n t i t h r o m b i n I I I be ing c lea red b y the l i ver . C o n s e q u e n t l y the p l a s m a leve ls of b o t h p r o t h r o m b i n a n d a n t i t h r o m b i n w o u l d be d e c r e a s e d , b u t the l eve l of f i b r i nogen w o u l d be p rese rved .