PROTHROMBIN

a carbohydrate-protein compound (glycoprotein) occurring in blood plasma and an essential component of the blood-clotting mechanism. Prothrombin is transformed into thrombin by a factor known as thromboplastin or prothrombinase; thrombin then acts to transform fibrinogen, also present in plasma, into fibrin, which, in combination with platelet cells from the blood, forms a clot. Under normal circumstances, prothrombin is changed into thrombin only when injury occurs to the tissues or circulatory system or both; hence, fibrin and blood clots are not formed except in response to bleeding. The disease hemophilia, in which bleeding will not stop once initiated, is caused by a hereditary lack of one of the factors necessary to convert prothrombin to thrombin. Hypoprothrombinemia, a deficiency in prothrombin, is characterized by a tendency to prolonged bleeding. It is usually associated with a lack of vitamin K, which is necessary for the synthesis of prothrombin in the liver cells. In adults the condition occurs most commonly in cases of obstructive jaundice, in which the flow of bile to the bowel is interrupted, bile being necessary for the intestinal absorption of vitamin K. It can also result from a general impairment in liver and intestinal-cell function or follow exposure to dicumarol and related therapeutic anticoagulants. In the newborn a lack of prothrombin leads to the condition known as hemorrhagic disease of the newborn, characterized by spontaneous internal and external hemorrhage, particularly from the umbilicus or mucous membranes; although this abnormal bleeding tends to run a short, self-limited course, it can sometimes have a fatal outcome. If suspected, it can be prevented by the administration of vitamin K to the mother during labour.