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.
