Non-Hypersplenism Causes of Peripheral Cytopenias in Patients with Cirrhotic Portal Hypertension: A Review

Lv, Yunfu; Lau, Wan Yee; Deng, Jie; Li, YeJuan; Dong, Yonghong

doi:10.4172/2167-1095.1000223

Cited by 2 publications

(4 citation statements)

References 40 publications

(37 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In 15.9% (62/390) of patient-times with peripheral cytopenia, the blood cells counts increased but they did not reach normal, indicating that in addition to hypersplenism other factors were involved. 23 Also, thrombocytopenia is related to thrombopoietin (TPO), and the more severe the liver cirrhosis, the worse the liver functional reserve, thus the more obvious the thrombocytopenia, and the poorer the prognosis. 35 TPO is almost specially produced by liver cells.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 However, according to Kalambokis and Tsianos, this etiology has not been well documented. 8 Many scholars have now reported that toxicity of hepatitis virus to bone marrow, [9][10][11] liver hypofunction, 12,13 gastrointestinal bleeding, 14 immune dysfunction, 15,16 drug toxicity, [17][18][19] peripheral platelet destruction, 20 hematopoietic disorders caused by vitamin and nutritional deficiency [21][22][23] and at the same time with the blood system diseases can also lead to peripheral cytopenia. Karasu and Tekin 24 stated that hypersplenism cannot be the only cause for patients with peripheral thrombopenia.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Causes of peripheral cytopenia in hepatitic cirrhosis and portal hypertensive splenomegaly

Lau

et al. 2017

Exp Biol Med (Maywood)

Self Cite

View full text Add to dashboard Cite

Impact statementFor a long time, the development of peripheral cytopenias as a complication to cirrhotic portal hypertension has been attributed to hypersplenism; however, this has never been fully demonstrated. Dameshek summarized that hypersplenism should be diagnosed by the presence of four conditions: (a) mono-or multi-lineage peripheral cytopenias; (b) compensatory hyperplasia of bone marrow; (c) splenomegaly; and (d) correction of cytopenias after splenectomy. We retrospectively analyzed the clinical data from 183 surgical patients, and found that 80.5% of peripheral cytopenias was caused by hypersplenism, 16% by a combination of factors, and 3.5% by other factors unrelated to hypersplenism. As the first quantitative findings in this field, our results verify that hypersplenism is a major, but not exclusive, cause of peripheral cytopenias, and provides important clinical evidence for investigating the cause of peripheral cytopenias. AbstractThe clinical data of 183 patients with hepatitic cirrhosis and portal hypertensive splenomegaly complicated by peripheral cytopenia were retrospectively analyzed to investigate the causes of peripheral cytopenia, as well as the proportion of the causes in these patients. All patients underwent splenectomy. Before operation, these patients had one or more types of peripheral cytopenia (cumulative cytopenia: 390 patient-times). After splenectomy, blood counts in 79.2% (309/390) returned to normal, while in 15.9% (62/390) they increased but failed to reach to normal levels, and in 4.9% (19/390) they became lower than before the operations. For the last group of patients (n ¼ 19), long-term follow-up showed that blood counts returned to normal in five patients. In other words, in 80.5% [(309 þ 5)/390 or 314/ 390] of patient-times, the peripheral cytopenia was due to hypersplenism, in 15.9% it was due to a combination of factors, and in 3.6% [14/390] it had nothing to do with the hypersplenism. Thus, hypersplenism is a major cause, but not the only cause, of peripheral cytopenia in patients with hepatic cirrhosis and portal hypertensive splenomegaly, and splenectormy is an effective treatment for these patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Causes of peripheral cytopenia in hepatitic cirrhosis and portal hypertensive splenomegaly

Lau

et al. 2017

Exp Biol Med (Maywood)

Self Cite

View full text Add to dashboard Cite

show abstract

“…The blood picture (hemogram) and blood film were done for all the 296 patients. Haematologically, hypersplenism was defined as leukocyte count of <4.0×109/L, an erythrocyte count of <4.0×1012/L, and/or a platelet count of <150×109/L [8]. The prevalence and pattern of hypersplenism were assessed.…”

Section: Assessment Of the Presence And Severity Of Hypersplenismmentioning

confidence: 99%

“…Depending mainly on the severity, cytopenia, was graded as mild, moderate, or severe, and given a total score of <2 points, 2-3 points, and >3 points, respectively. PLTs count of 50-100×109/L was scored as 1, 30-50×109/L as 2, and <30×109/L as 3; a RBCs count of 3-4×1012/L was scored as 0, and <3×1012/L as 1; a WBC count of 2-4×109/L was scored as 0, and <2×109/L as 1 [8]. Presence of hypersplenism in patients with cirrhosis and PHT, was assessed in comparison with those who did not develop hypersplenism, and comparison between different grades of hypersplenism was also done, as regards to Child-Pugh score, MELD score, presence of HCC, PVT, ascites, portosystemic collaterals, portal haemodynamic and other clinical data.…”

Section: Assessment Of the Presence And Severity Of Hypersplenismmentioning

confidence: 99%

"Hypersplenism in Patients with Liver Cirrhosis and Portal Hypertension: Predictors, and Correlations"

M Hassany

2024

BJSTR

View full text Add to dashboard Cite

Background & Aim: Hypersplenism is a common disorder in the setting of liver cirrhosis and portal hypertension (PHT). The presence of hypersplenism suggests more advanced liver disease and an increased risk of complications. This work tried to assess frequency of hypersplenism, correlations, and its predictors in patients with liver cirrhosis and PHT.Patients and Methods: Our study included 303 patients with liver cirrhosis and PHT, and 7 patients were excluded later. The study was carried out at AlRajhi Liver hospital, Assiut University, Egypt, from February 2018 to December 2021. All patients were subjected to full clinical evaluation, laboratory investigations, abdominal Ultrasound, and upper endoscopy. Portal hemodynamic were assessed in 100 patients using doppler ultrasound.Results: A total of 182 patients (61.5%) were found to have hypersplenism. Chronic HCV infection was the causative agent of cirrhosis in most patients (70.9%), with no significant difference between both groups. Chronic co-morbid diseases were not found to affect the development of hypersplenism. We have found significant differences between the hypersplenism and non-hypersplenism group regarding all clinical presentation data. As regards to sonographic findings, patients with hypersplenism had significantly higher splenic diameter (p< 0.001), portal vein diameter, more frequent portosystemic collaterals, portal vein thrombosis and HCC. Also, frequency of ascites, especially marked ascites, was significantly higher (p< 0.001), Regarding portal hemodynamic parameters, portal vein velocity (PVV) and time averaged mean velocity (TAMV), were the doppler parameters which showed significant differences between both groups (p=0.026 & 0.033). Predictors of hypersplenism, were in descending order; ascites, haematemesis and or melena, PV diameter, splenic diameter, PVV, and the presence of portosystemic collaterals. Patients with hypersplenism were categorized according to severity using a scoring index, into mild and moderate/severe, but no significant difference was found between both groups, apart from significant high frequency of varices. Conclusion:Hypersplenism is a common disorder in the setting of liver cirrhosis and PHT. The development of hypersplenism is associated with advanced liver disease, and increased risk of disease related complications. Ascites, haematemesis and or melena, PV diameter, splenic diameter, PVV, and portosystemic collateral may predict the development of hypersplenism. Doppler US may be used as a non-invasive marker for PHT and hypersplenism.

show abstract

Non-Hypersplenism Causes of Peripheral Cytopenias in Patients with Cirrhotic Portal Hypertension: A Review

Cited by 2 publications

References 40 publications

Causes of peripheral cytopenia in hepatitic cirrhosis and portal hypertensive splenomegaly

Causes of peripheral cytopenia in hepatitic cirrhosis and portal hypertensive splenomegaly

"Hypersplenism in Patients with Liver Cirrhosis and Portal Hypertension: Predictors, and Correlations"

Contact Info

Product

Resources

About