Download PDF
Thromb Haemost 1979; 42(05): 1529-1535
DOI: 10.1055/s-0038-1657055
Original Article
Schattauer GmbH Stuttgart

Effects of Splenectomy on Blood Coagulation and Fibrinolysis in Patients with Liver Cirrhosis: Possible Role of the Spleen in Haemostasis

Isao Kamisasa
The 2nd Department of Surgery and Department of Central Clinical Laboratory, Tokyo University School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
,
Koh Hidai
The 2nd Department of Surgery and Department of Central Clinical Laboratory, Tokyo University School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
,
Mrrsuo Sugiura
The 2nd Department of Surgery and Department of Central Clinical Laboratory, Tokyo University School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
,
Tatsuo Wada
The 2nd Department of Surgery and Department of Central Clinical Laboratory, Tokyo University School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
,
Manabu Yamanaka
The 2nd Department of Surgery and Department of Central Clinical Laboratory, Tokyo University School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
› Author Affiliations
Further Information

Publication History

Received 23 March 1979

Accepted 31 October 1979

Publication Date:
18 February 2019 (online)

  PDF Download  Permissions and Reprints

Summary

Blood coagulation and fibrinolysis before and after splenectomy was studied in 74 cases of liver cirrhosis. A hypocoagulable state was found before splenectomy, but the platelet count, and the levels of fibrinogen, plasminogen, ±2-macroglobulin and antithrombin III increased significantly after splenectomy (p < 0.05 to p < 0.001). A marked improvement was observed on the values of r (reaction time), k (clot formation time) and ma (maximal amplitude) of thrombelastograms (p < 0.05 to p < 0.001). The prothrombin time was reduced after the surgery, but not significantly (0.05 < p < 0.1). The levels of arantitrypsin remained almost unchanged, while serum fibrinogen-fibrin degradation products (FDP) showed a slight decrease postoperatively.

The immunohistologic study of the spleen excised from 7 cases with liver cirrhosis, with the use of the direct immunofluorescence technique, demonstrated the deposits of fibrin in the splenic cords in all cases. It was not recognized in the spleens of 4 cases without cirrhosis used as the control.

A further study of the spleen weight and plasma fibrinogen level showed that a significant inverse correlation exists between these two parameters (p < 0.01).

These findings suggest that localized intravascular coagulation (LIC) occurs in the enlarged spleen associated with liver cirrhosis.

 

  • References

  • 1 Bergström K, Blombäck B, Kleen G. 1960; Studies on the plasma fibrinolytic activity in a case of liver cirrhosis. Acta Medica Scandinavica 168: 291
    PubMedGoogle Scholar
  • 2 Collen D, Rouvier J, Verstraete M. 1972; Metabolism of iodine-labelled plasminogen and prothrombin in cirrhosis of the liver. Clinical Research 20: 483
    PubMedGoogle Scholar
  • 3 Fischer M, Gauss P, Korp W, Nobis H, Schnack H, Weissmann A. 1973; Heparin Therapy in the case of acute liver cirrhosis. Scandinavian Journal of Gastroenterology (Suppl.) 19: 135
    PubMedGoogle Scholar
  • 4 Fisher S. 1968; Cryptgenetic congestive severe coagulopathy in splenomegaly. Journal of the American Medical Association 205: 101
    CrossrefPubMedGoogle Scholar
  • 5 Forman WB, Bahnhart MI. 1964; Cellular site for fibrinogen synthesis. Journal of the American Medical Association 187: 168
    PubMedGoogle Scholar
  • 6 Gerrits WB J, Van Aken WG, Van Der Meer J, Vreeken J. 1974; Splenomegaly associated with chronic consumption coagulopathy. Acta Medica Scandinavica 195: 425
    PubMedGoogle Scholar
  • 7 Horder MH. 1969; Consumption coagulopathy in liver cirrhosis. Thrombosis et Diathesis Haemorrhagica (Suppl.) 36: 313
    PubMedGoogle Scholar
  • 8 Johansson SA. 1964; Studies on blood coagulation factors in a case of liver cirrhosis. Acta Medica Scandinavica 175: 111
    PubMedGoogle Scholar
  • 9 Mancini G, Carbonara A, Heremans JF. 1965; Immunochemical quantitation of antigens by single radial immunodiffusion. Immunochemistry 2: 235
    CrossrefPubMedGoogle Scholar
  • 10 Merskey C, Lalezari P, Johnson AJ. 1969; A rapid, simple sensitive method for measuring fibrinolytic split products in human serum. Proceedings of the Society for Experimental Biology and Medicine 131: 871
    PubMedGoogle Scholar
  • 11 Previato G, Bertaglia E, Reggio A, Galfano M, Lo Schiavo C, Gritti G, Zorn S, Farin R, Naccarato R. 1974; La sindrome emorragica nelle epatopatie acute e croniche. Giornale di Clinica Medica 55: 691
    PubMedGoogle Scholar
  • 12 Quick AJ. 1935; The prothrombin in hemophilia and obstructive jaundice. Journal of Biological Chemistry 109: 73
    PubMedGoogle Scholar
  • 13 Quick AJ. 1957. Hemorrhagic disease. 1. ed Lea and Febiger; Philadelphia:
    Google Scholar
  • 14 Roberts HR, Cederbaum AI. 1972; The liver and blood coagulation: Physiology and pathology. Gastroenterology 63: 297
    CrossrefPubMedGoogle Scholar
  • 15 Straub PW. 1977; Diffuse intravascular coagulation in liver disease? Seminars in Thrombosis and Hemostasis. 4: 29
    PubMedGoogle Scholar
  • 16 Tytgat GN, Collen D, Verstraete M. 1971; Metabolism of fibrinogen in cirrhosis of the liver. Journal of Clinical Investigation 50: 1690
    CrossrefPubMedGoogle Scholar
  • 17 Van Outryve M, Baele G, De Weerdt GA, Barbier F. 1973; Antihaemophilic factor A (F VIII) and serum fibrin-fibrinogen degradation products in hepatic cirrhosis. Scandinavian Journal of Haematology 11: 148
    PubMedGoogle Scholar
  • 18 Vergoz D, Levy VG, Najman A, Caroli J. 1967; Variations du facteur V au cours des spl�nectomies dans les cirrhoses. Revue francaise detudes cliniques et biologiques 12: 725
    PubMedGoogle Scholar
  • 19 Verstraete M, Vermylen C, Vermylen J, Vandenbroucke J. 1965; Excessive consumption of blood coagulation components as cause of hemorrhagic diathesis. American Journal of Medicine 38: 899
    CrossrefPubMedGoogle Scholar
  • 20 Verstraete M, Vermylen J, Collen D. 1974; Intravascular coagulation in liver disease. Annual Review of Medicine 25: 447
    CrossrefPubMedGoogle Scholar
  • 21 Zetterqvist E, Von Francken I. 1963; Coagulation disturbances with manifest bleeding in extrahepatic portal hypertension and liver cirrhosis. Acta Medica Scandinavica 173: 753
    PubMedGoogle Scholar