Haematological changes in active chronic hepatitis with reference to the role of the spleen.

Toghill, P J; Green, S

doi:10.1136/jcp.28.1.8

Cited by 6 publications

(4 citation statements)

References 12 publications

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“…How much this effect is responsible for the encouraging rise in platelet count after splenectomy in active chronic hepatitis (Boye et al, 1972) is uncertain. Undoubtedly in some patients with active chronic hepatitis the thrombocytopenia may be part of an 'immune crisis' (Toghill and Green, 1975), and although the role of splenectomy in these circumstances is speculative some results have been heartening (Fodor and Barbarino, 1972). Reducing portal pressure may be important in improving platelet survival, as was the case with our patient (Case 11) after a splenorenal shunt and in other patients with portocaval shunting (Castaldi and Firkin, 1963).…”

Section: Discussionmentioning

confidence: 99%

Platelet dynamics in chronic liver disease with special reference to the role of the spleen.

Toghill¹,

Green²,

Ferguson³

1977

J Clin Pathol

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SUMMARY In all of 12 patients with chronic liver disease, whose platelet dynamics were investigated by the 51Cr-labelling technique in association with surface counting, platelet survival was reduced and in Ithe splenic platelet pool was increased. Surface counting showed high initial spleen:liver ratios in eight patients, and in four there was evidence of progressive destruction of platelets in the spleen. In one patient, subsequently shown to have a hepatoma, progressive accumulation of platelets was noted at the tumour site.

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Section: Discussionmentioning

confidence: 99%

Platelet dynamics in chronic liver disease with special reference to the role of the spleen.

Toghill¹,

Green²,

Ferguson³

1977

J Clin Pathol

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“…Measurements of red cell mass (RCM), splenic red cell pool (SRCP), red cell survival (RCS) and surface counting studies were also carried out in Cases 3, 4, 7, 8, 9 and 11, using "Cr-labelled erythrocytes as described earlier (Toghill and Green, 1975). Plasma volumes (PV) were measured using lZ5I-or 1311-labelled human albumin.…”

Section: Methodsmentioning

confidence: 99%

Splenectomy for undiagnosed splenomegaly

Goonewardene

Bourke

Ferguson

et al. 1979

Journal of British Surgery

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During the 9-year period 1968-76 116 splenectomies were performed at the General Hospital, Nottingham. Of these, 13 (11 per cent) were undertaken for unexplained splenomegaly. In 6 patients a diagnosis was established by the operative procedure (2 with sarcoidosis, 2 splenic cysts, 1 Gaucher's disease and 1 haemangiosarcoma). Histological examination of the excised spleens in the remaining 7 patients showed no specific features. Two of these patients benefited considerably from removal of very large spleens. Another patient died from lymphosarcoma which was diagnosed 21 months after splenectomy. In the remaining 4 patients with mild to moderate splenomegaly, there were no real diagnostic or therapeutic advantages. It is concluded that splenectomy should always be considered in patients with unexplained moderate or gross splenomegaly but it may not be helpful in the patient whose spleen is only midly enlarged.

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“…The low platelet count is commonly independent of the cause of liver disease, but it seems to be related to the degree of liver failure [3]. The mechanism of thrombocytopenia has been attributed mainly to hypersplenism [4,5], although other factors such as reduced mean life span with increased platelet turnover have also been demonstrated [6-81. The key role played by the spleen has been challenged by studies showing no relation between the low platelet count and the presence of splenomegaly [9] and by the observations that surgical procedures such as portocaval shunts do not usually normalize the platelet count [ 101. However, recent kinetics studies have shown that the sequestration of platelets by the spleen is a prominent feature in patients with CLD [8,11], but it is still uncertain whether the platelets are removed as a result of the spleen function or due to an intrinsic damage of the platelets, specifically, at the level of the platelet membrane.…”

Section: Introductionmentioning

confidence: 99%

Platelet autoantibodies in patients with chronic liver disease

et al. 1995

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The thrombocytopenia in chronic liver disease (CLD) has been attributed mainly to hypersplenism, although other factors such as reduced mean life span with increased platelet turnover have also been demonstrated. Immunological abnormalities have been described in the pathogenesis and progression of CLD. In this sense, many studies have reported elevated levels of platelet associated IgG (PAIgG) in patients with CLD, and it has been suggested that PAIgG could represent true antiplatelet antibody. In this study we used a glycoprotein (GP)-specific immunoassay (MACE) to determine whether PAIgG or circulating antiplatelet antibodies, reacted against the GPIIb/IIIa or GPIb/IX complexes, in patients with CLD. Thirty-six patients with CLD of diverse etiology were studied (20 female, mean age 53 years, range 38-75 years). 23 out of 36 patients (64%) had anti-GP antibodies in MACE. Particularly, 12 had anti-GPIb, 4 anti-GPIIb/IIIa, and 7 had both types of autoantibodies. The existence of these anti-GP antibodies was not related with the blood platelet count or etiology of CLD. These data show that in patients with CLD of diverse origin, there is a high prevalence of autoantibodies reacting specifically with platelet membrane GP, which constitutes the first evidence of the specific nature of platelet-bound IgG in CLD. These findings suggest that in patients with CLD, an immune mechanism may participate in inducing or aggravating the thrombocytopenia.

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Haematological changes in active chronic hepatitis with reference to the role of the spleen.

Cited by 6 publications

References 12 publications

Platelet dynamics in chronic liver disease with special reference to the role of the spleen.

Platelet dynamics in chronic liver disease with special reference to the role of the spleen.

Splenectomy for undiagnosed splenomegaly

Platelet autoantibodies in patients with chronic liver disease

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