Des-gamma carboxyprothrombin

Des-gamma-carboxy-protrombin DCP is a biologically inactive, immature form of prothrombin, which is one of the coagulation factorsós produced in the liver.

During normal metabolism, Des-gamma-carboxy-protrombin undergoes a series of transformations in the liver to its active form-prothrombin. Under physiological conditions, in plasma, with the participation of other enzymesós and calcium ionsós, prothrombin is further transformed to thrombin, whichós directly involved in the blood clotting cascade.

The above reactions can be impaired in cases of vitamin K deficienciesós or liver cancerós. Both of these conditions result in a blockade of the conversion of DCP to prothrombin and an increase in its plasma level. The consequences of the above are impaired blood clotting, whichóre likely to manifest as hemorrhages and bruising.

One diseaseób in which the determination of DCP levels may prove useful is a type of primary liver cancer called hepatocellular carcinoma (HCC). It is particularlyólly common following chronic viral B or C inflammation and alcohol abuse.

The diagnostic problem remains to separate this type of lesion from cirrhosis, whichóra can be caused by similar causes.

The basis for the diagnosis of liver tumorsós is abdominal ultrasound. Benign lesions usually do not produce symptomsów and are detected incidentally during testsów performed for other reasons. In suspicious cases, laboratory determinations are used as an adjunct to imaging studies.

When to perform the determination?

The DCP assay is used in the follow-up diagnosis of hepatocellular carcinomaór cancer HCC. Once liver lesions are detected by imaging studies, DCP should be assayed along with other biochemical markers-mainly alpha-fetoprotein (isoenzyme AFP-L3) and carcinoembryonic antigen (CEA).

The DCP assay should be performed in conjunction with other biochemical markers

If initial levels are elevated, it can then be ordered periodically in monitoring disease progression, during and after HCC treatment (to assess its effectiveness).

Additionally, an abnormal result of simultaneous determination of AFP and DCP is also rótreated as an independent risk factor for aggressive disease progression.

Other abnormalities in laboratory tests that may indicate the development of liver cancer are: elevation of LDH (isoenzymes LDH2 , LDH3 and LDH4), increase in alkaline phosphatase ALP (liver isoenzyme), increase in GTP, aminotransferases AST and ALT.

Who should have their DCP levels determined?

Persons with symptoms thatóre likely to be caused by any cancerór developing in the body: loss of appetite and weight, weakness, fatigue, prolonged subfebrile states, non-painful enlargement of lymph nodesór or suspicious skin lesionsór in various areas of the body.

Otherwise, people with symptoms thatóre likely to indicate cancerór of the liver: abdominal painór diarrhea, nausea, vomiting, an enlarged mass under the right ribs, a complaintór of eye whites and skinór, itchy skinór, swelling, dark urine, light stool.

Sometimes liver cancerór is diagnosed only when liver failure develops. It manifests itself: a drop in blood pressure, enlargement of the abdominal circumference, fever, bloody petechiae on the skinóriver, gastrointestinal bleeding, symptoms of acute abdomen, and disturbance of consciousness.

The liver failure is not diagnosed until the liver fails

Test material

• venous blood

Des-gamma-carboxy-protrombin norm

Reference values up to 7.5 ng/ml.

Des-gamma-carboxy-protrombin results

Low DCP levels in a person with suspected liver lesions reduce the likelihood of hepatocellular carcinomaór HCC, but do not rule out the disease. The tumor may not produce DCP or may be so small that it does not produce significant amounts.

An increased level of DCP in a person with diagnosed (confirmed by liver biopsy) hepatocellular carcinomaór HCC means that the tumorór producing this substance and the test can be used as a tumor marker. Declining concentrations in peopleóy undergoing therapy, suggest a positive response to treatment. A sharp increase in the concentration of the substance, along with the levels of other indicatorsós, can herald a relapseót of the disease.

An increase in DCP levels is also detected in patients with deficiency of vitamin K (due to nutritional deficiencies or intestinal malabsorption syndromes), treated with anticoagulants that inhibit its action, or some antibiotics.