Thromb Haemost 1988; 59(02): 316-318
DOI: 10.1055/s-0038-1642778
Original Articles
Schattauer GmbH Stuttgart

The Effect of Fulminant Hepatic Failure on Protein C Antigen and Activity

P G Langley
The Liver Unit, King’s College Hospital and School of Medicine and Dentistry, London, UK
,
Roger Williams
The Liver Unit, King’s College Hospital and School of Medicine and Dentistry, London, UK
› Author Affiliations
Further Information

Publication History

Received 23 July 1987

Accepted after revision 28 December 1987

Publication Date:
21 May 2018 (online)

Summary

In eighteen patients with fulminant hepatic failure (FHF), ingrade III or IV coma, both protein C antigen and activity weresignificantly decreased (0.35 ± 0.03 u/ml and 0.35 ± 0.03 u/ml respectively). There was a significant correlation between pro-tein C antigen and activity (r = 0.61, p <0.01). Protein C antigenlevels were inversely correlated with prothrombin time (r =−0.57, p <0.05) as were protein C activity levels (r = —0.57, p<0.05). There was also significant correlations between fibrinogen and protein C antigen (r = 0.69, p <0.01) and protein Cactivity (r = 0.61, p <0.01). These results demonstrate that thenaturally occurring inhibitor of coagulation, protein C, is presentat low levels in FHF and this is probably due to the lack ofsynthesis of the protein in the damaged liver. The low levels ofprotein C may make these patients more susceptible to thedisseminated intravascular coagulation which is known to occur inFHF and this in turn will lead to a further reduction in protein Clevels.

 
  • References

  • 1 O’Grady JG, Langley PG, Isola LM, Aledort LM, Williams R. Coagulopathy of fulminant hepatic failure. Seminars in Liver Disease 1986; 6: 159-163
  • 2 Fair DS, Marler RA. Biosynthesis and secretion of factor VIII, protein Cprotein S and the protein C inhibitor from a humanhepatoma cellline. Blood 1986; 67: 64-70
  • 3 Stenflo J. A new vitamin K-dependent protein: purification frombovine plasma and preliminary characterization. J Biol Chem 1976; 251: 355-363
  • 4 Fulcher CA, Gardiner JE, Griffin JH, Zimmerman TS. Proteolyticinactivation of human factor VIII procoagulant protein by activatedprotein C and its analogy with factor V. Blood 1984; 63: 486-489
  • 5 Griffin JH, Evatt B, Zimmerman TS, Kleiss AJ, Wideman C. Deficiency of protein C in congenital thrombotic disease. J Clin Invest 1981; 68: 1370-1375
  • 6 Bertina RM, Broekmans AW, van der Linden IK, Mertens K. Protein C deficiency in a dutch family with thrombotic disease. Thromb Haemostas 1982; 48: 1-5
  • 7 Laurell CB. Quantitative estimations of proteins by electrophoresis inagarose gel containing antibodies. Anal Biochem 1966; 15: 45-52
  • 8 Bertina RM, Broekmans AW, van Krommenhoek Es, van Wijngaar-den A. The use of a functional and immunological assay for plasmaprotein C in the study of the heterogeneity of congenital protein Cdeficiency. Thromb Haemostas 1984; 51: 1-5
  • 9 Griffin JH, Mosher DF, Zimmerman TS, Kleiss AJ. Protein C, antithrombotic proteinis reduced in hospitalised patients withintravascular coagulation. Blood 1982; 60: 261-264
  • 10 Mannucci PM, Vigano S. Deficiences of protein Can inhibitor ofblood coagulation. Lancet 1982; II: 463-467
  • 11 Comp PC, Nixon RR, Esmon CT. Determination of functional levelsof protein Can antithrombotic proteinusing thrombin-throm-bomodulin complex. Blood 1984; 63: 15-21
  • 12 Epstein DJ, Bergum PW, Bajaj SP, Rapaport SI. Radioimmunoassays for protein C and factor X Plasma antigen levelsin abnormal hemostatic states. Amer J Clin Pathol 1984; 82: 573-81
  • 13 D’Angelo SV, Comp PC, Esmon CT, D’Angelo A. Relationshipbetween protein C antigen and anticoagulant activity during oralanticoagulation and in selected disease states. J Clin Invest 1986; 77: 416-425
  • 14 Hughes RD, Lane DA, Ireland H, Langley PG, Gimson AE S, Williams R. Fibrinogen derivatives and platelet activation products inacute and chronic liver disease. Clin Sci 1986; 68: 701-707
  • 15 Friberger P, Egberg N, Holmer E, Hellgren M, Blomback M. Antithrombin assay– the use of human or bovine thrombin and theobservation of a “second” heparin cofactor. Thromb Res 1982; 25: 433-436
  • 16 Tollefsen DM, Pestka CA. Heparin cofactor II activity in patientswith disseminated intravascular coagulation and hepatic failure. Blood 1985; 66: 769-774