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Revista do Instituto de Medicina Tropical de São Paulo

On-line version ISSN 1678-9946

Rev. Inst. Med. trop. S. Paulo vol.30 no.4 São Paulo July/Aug. 1988 



Hypoprothrombinemia in the compensated form of hepatosplenic schistosomiasis: further studies


Hipoprotrombinemia na forma-compensada da esquistossomose hepatoesplênica: novos estudos



Nora Manoukian; Durval Rosa Borges

Division of Gastroenterology, Department of Medicine "Escola Paulista de Medicina", São Paulo, SP., Brazil

Address for correspondence




Coagulation abnormality is frequently observed in schistosomiasis patients but its pathophysiology has not been established. We measured, by immunodiffusion. the prothrombin-antigen concentration in 56 individuals; of these 19 with demonstrated compensated form of hepatosplenic schistosomiasis, 17 with cirrhosis and 20 were control subjects. Transaminases, albumin, transthyretin, prothrombin time, antithrombin III, factor VII, and fibrinogen were also evaluated.
All parameters were altered in the cirrhotic group but only albumin, prothrombin and antithrombin III levels were altered in the schistosomiasis group. Ninety percent of the patients with cirrhosis and sixty percent of the patients with schistosomiasis had abnormal plasma levels of albumin, transthyretin, prothrombin-antigen, and/or antithrombin III; an impaired hepatic synthesis was responsible for these results.
Conversely forty percent of the schistosomiasis patients with normal plasma concentrations of both albumin and transthyretin had decreased mean plasma levels of both prothrombin and antithrombin III. These results suggest that either proth rombin and antithrombin III are more sensitive markers of impaired hepatic synthesis in schistosomiasis than are levels of albumin and transthyretin combined, or a low grade chronic consumption of clotting proteins also occurs. Considering the latter hypothesis it is possible that the thrombin formed would be inhibited by antithrombin III with the complexed thrombin-antithrombin III being cleared by the liver. Consequently the plasma levels of both prothrombin and antithrombin would be decreased, but the level of fibrinogen would be preserved.

Key words: Prothrombin; Antithrombin III; Schistosomiasis; Coagulopathy.


Alterações na coagulação são frequentemente observadas em portadores da esquistossomose, mas sua fisiopatologia ainda não foi estabelecida. Medimos, por imunodifusão, a concentração da protrombina-antígeno em 56 indivíduos: 19 com a forma compensada da esquistossomose hepatoesplênica 17 com cirrose e 20 sadios. Foram também determinadas transaminases, albumina, transtiretina, tempo de protrombina, antitrombina III, fator VII e fibrinogênio.
As médias de todos os parâmetros estavam alteradas no grupo cirrótico mas apenas as de albumina, protrombina e antitrombina III no grupo esquistossomótico. Noventa por cento dos portadores de cirrose e 60% dos portadores de esquistossomose tinham níveis plasmáticos diminuídos de albumina, transtiretina, protrombina e/ou antitrombina III; síntese hepática diminuída pode explicar estes resultados.
Por outro lado, em 40% dos portadores de esqtiistossomose com concentrações plasmáticas de albumina e transtiretina normais as concentrações médias de protrombina e antitrombina III estavam diminuídas. Estes resultados sugerem que a protombina e antitrombina III são marcadores mais sensíveis de síntese hepática do que o conjunto albumina/transtiretina ou que um consumo crônico das proteínas da coagulação ocorra. Considerando esta última possibilidade é possível supor-se que a trombina formada seja inibida pela antitrombina III e o complexo trombina-antitrombina III depurado pelo fígado. Consequentemente os níveis plasmáticos de protrombina e antitrombina III diminuem mas o do fibrinogênio é preservado.



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Address for correspondence:
Dr. Durval Rosa Borges
Caixa Postal 20239. CEP 04034 São Paulo. SP., Brazil

Recebido para publicação ern 09/3/1988.

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