Associating portal congestive gastropathy and hepatic fibrosis in hepatosplenic mansoni schistosomiasis

Dias, Heloisa Soares; Domingues, Ana Lúcia Coutinho; Cordeiro, Fernando; Jucá, Norma Thomé; Lopes, Edmundo Pessoa

doi:10.1016/j.actatropica.2013.02.011

Cited by 16 publications

(13 citation statements)

References 22 publications

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“…Due to the fibrotic process and venous congestion, HS patients develop hemodynamic changes associated with splenomegaly and high morbidity rates ( 16 ) . In a recently study in the same region, Dias et al ( 17 ) showed that 61% of HS patients had advanced or very advanced periportal fibrosis. In the current study, all HS patients presented with a severe form of HS and portal hypertension, 38 (69%) had advanced and very advanced liver fibrosis (pattern E+F) and 34 (61.8%) patients had gastrointestinal bleeding.…”

Section: Discussionmentioning

confidence: 94%

“…Anemia in patients with liver disease is often multifactorial and may be associated with iron and folic acid deficiency or even an inflammatory process. Red blood cell survival is often shortened in chronic liver disease with the increased spleen being a major site of red blood cell destruction ( 17 ) . In this study, high frequencies of thrombocytopenia (74.1%), leukopenia (47.3%), anemia (36.3%), bicytopenia (30.9%) and pancytopenia (18.2%) were found.…”

Section: Discussionmentioning

confidence: 99%

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Relationship between splenomegaly and hematologic findings in patients with hepatosplenic schistosomiasis

Leite¹,

Domingues²,

Lopes³

et al. 2013

Revista Brasileira De Hematologia E Hemoterapia

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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.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Relationship between splenomegaly and hematologic findings in patients with hepatosplenic schistosomiasis

Leite¹,

Domingues²,

Lopes³

et al. 2013

Revista Brasileira De Hematologia E Hemoterapia

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“…Abdominal ultrasound was performed by a single researcher (ALCD) through the Acuson X 150 device, with a 3.5 mHz convex transducer (Siemens), for diagnosis, to classify the different patterns of PPF and to exclude other liver diseases such as steatosis and cirrhosis. The Niamey classification of PPF was used: pattern D (central or moderate fibrosis), pattern E (advanced fibrosis) and pattern F (very advanced fibrosis) [ 20 – 21 ].…”

Section: Methodsmentioning

confidence: 99%

Splenectomy Improves Hemostatic and Liver Functions in Hepatosplenic Schistosomiasis Mansoni

et al. 2015

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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.

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“…These patients with more advanced fibrosis patterns and with both platelet count and spleen size outside the range of normality have the hepatosplenic form of disease (8) . Additionally, they presented higher levels of portal pressure and a consequently greater risk of digestive bleeding (6,21) . In clinical practice, propaedeutic methods for the diagnosis, measurement and follow up of periportal fibrosis continue to be necessary.…”

Section: Discussionmentioning

confidence: 99%

Correlation Between Platelet Count and Both Liver Fibrosis and Spleen Diameter in Patients With Schistosomiasis Mansoni

Medeiros

Domingues

Luna

et al. 2014

Arq. Gastroenterol.

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-Context -Studies have described the correlation between platelet count and the stages of fibrosis in chronic viral hepatitis, but few publications have studied this correlation in Schistosomiasis mansoni. Objective -Therefore, this study aimed to correlate platelet count with both the periportal fibrosis pattern and spleen diameter evaluated by ultrasound exam in patients with Schistosomiasis mansoni. Methods -Patients with Schistosomiasis mansoni were evaluated by abdominal ultrasound by a single examiner for the determination of periportal fibrosis pattern (Niamey classification) and spleen diameter. Platelet counts were performed in an automated cell counter. Results -One hundred eighty-seven patients with Schistosomiasis mansoni (mean age: 50.2 years) were included in the study, 114 of whom (61%) were women. Based on the Niamey classification, the ultrasound analysis revealed that 37, 64, 64 and 22 patients exhibited patterns C, D, E and F, respectively. In these four groups, the mean number of platelets was 264, 196, 127 and 103 x 10 9 /L and mean spleen diameter was 9.2, 11.9, 14.9 and 16.2 centimeters, respectively. A reduction in platelet count was significantly associated with both the progression of the periportal fibrosis and the increase in spleen size. Conclusion -Platelet count in patients with Schistosomiasis mansoni was inversely correlated with the severity of periportal fibrosis and spleen diameter. HEADINGS -Liver fibrosis. Platelet count. Splenomegaly. Thrombocytopenia. Portal hypertension. Schistosomiasis mansoni.

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Associating portal congestive gastropathy and hepatic fibrosis in hepatosplenic mansoni schistosomiasis

Cited by 16 publications

References 22 publications

Relationship between splenomegaly and hematologic findings in patients with hepatosplenic schistosomiasis

Relationship between splenomegaly and hematologic findings in patients with hepatosplenic schistosomiasis

Splenectomy Improves Hemostatic and Liver Functions in Hepatosplenic Schistosomiasis Mansoni

Correlation Between Platelet Count and Both Liver Fibrosis and Spleen Diameter in Patients With Schistosomiasis Mansoni

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