Severe thrombocytopenia due to hypersplenism treated with partial splenic embolisation

Hanafiah, Mohammad; Shahizon, Azura Mohamed Mukhari; Low, Soo Fin; Shahrina, Man Harun

doi:10.1136/bcr-2013-010163

Cited by 3 publications

(6 citation statements)

References 8 publications

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“…PSE is more favorable than splenectomy as it is generally a gentler approach and is associated with lower mortality rate. 5 Splenic embolization for hypersplenism was first performed in the 1970s. After that many studies have been conducted to assess the effect on pancytopenia and variceal bleeding.…”

Section: Discussionmentioning

confidence: 99%

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Pancytopenia and Massive Gastroesophageal Bleeding Due to Hypersplenism Treated with Partial Splenic Embolization

Muradi

Waznan

Jasirwan

et al. 2019

JINASVS

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Introduction: Portal hypertension may cause gastrointestinal complications; one of the most serious is a ruptured esophageal varices. Portal hypertension is also the main cause of hypersplenism, which in turn could lead to pancytopenia. Despite adequate therapy, some cases of hypersplenism could not be resolved. Partial splenic embolization (PSE) is an effective alternative method to treat this condition. Method: We reported two cases of hypersplenism treated with PSE. The first case was a 10- year-old girl with pancytopenia and a history of recurrent esophageal ligation. The second case was a 32-year-old man with recurrent episodes of hematemesis for two years before admission. Results: After the PSE procedure, the first patient’s white blood cell and platelet doubled in one month after procedure and stable at follow-up three months later, with no complaint of hematemesis. The second patient’s platelet doubled five days after the procedure. The first patient developed a complication of a splenic abscess, but after antibiotic administration and pus drainage, the condition was resolved. Conclusion: PSE is an effective method to treat hypersplenism secondary to the hypertensive portal. Treatment goals successfully achieved include improvement in blood count and control of bleeding. There are risks following PSE, but with adequate treatment, it can be overcome. Keywords: hypersplenism, partial splenic embolization, portal hypertension, pancytopenia

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Section: Discussionmentioning

confidence: 99%

“…PSE is normally reserved because of its potential complications, which are a postembolization syndrome, splenic abscess, splenic rupture, and gastrointestinal bleeding. 5 These cases are an example of the use of PSE as an effective method to treat pancytopenia and massive gastrointestinal bleeding and its potential complication.…”

Section: Portalmentioning

confidence: 99%

Pancytopenia and Massive Gastroesophageal Bleeding Due to Hypersplenism Treated with Partial Splenic Embolization

Muradi

Waznan

Jasirwan

et al. 2019

JINASVS

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“…Owing to the lack of effective pharmacologic therapies currently available to increase platelet count, surgical splenectomy has been performed in these situations but has been discontinued due to high mortality rate 1617. Instead, partial splenic embolization (PSE) was proposed as an alternative strategy to surgery for improving severe thrombocytopenia due to hypersplenism 18.…”

Section: Introductionmentioning

confidence: 99%

“…Instead, partial splenic embolization (PSE) was proposed as an alternative strategy to surgery for improving severe thrombocytopenia due to hypersplenism 18. PSE via splenic arterial catheterization to occlude a portion of the splenic arterial blood flow resulting in partial splenic necrosis is a minimally invasive approach with low mortality and has been known to be an effective method to treat hypersplenism in cirrhotic patients with severe thrombocytopenia 81619202122. It may enable HCC patients with severe thrombocytopenia related to splenomegaly to undergo TACE procedures.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Efficacy and Safety of Partial Splenic Embolization in Hepatocellular Carcinoma Patients with Thrombocytopenia Who Underwent Transarterial Chemoembolization

Kim

Cho

et al. 2019

J Korean Med Sci

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Background Performing transarterial chemoembolization (TACE) is difficult with the occurrence of thrombocytopenia in cirrhotic patients with hepatocellular carcinoma (HCC). We aimed to evaluate the long-term efficacy and safety of partial splenic embolization (PSE) combined with TACE in patients with HCC with severe thrombocytopenia related to splenomegaly. Methods We conducted a case–control study consisting of 18 HCC patients with severe thrombocytopenia (< 50 × 10 9 /L) who underwent PSE concurrently with TACE (PSE group) and 72 controls who underwent TACE alone (non-PSE group). Results Mean platelet counts at 1 month and 1, 3, and 5 years after concurrent PSE and TACE significantly increased compared with baseline (all P < 0.05), whereas the platelet count did not significantly increase after TACE alone. In addition, the platelet count at several time points after treatment in the PSE group was significantly higher than that in the non-PSE group, although the baseline platelet count in the PSE group was significantly lower than that in the non-PSE group. The platelet increase after PSE significantly reduced the need for platelet transfusions ( P = 0.040) and enabled the subsequent TACE procedures in time ( P = 0.046). The leukocyte counts and hemoglobin concentrations after concurrent PSE and TACE were also significantly increased, without deterioration of Child-Turcotte-Pugh score and unexpected side effects. Conclusion PSE combined with TACE is effective in inducing and maintaining long-term thrombocytopenia improvement which reduces the need for the platelet transfusion and helps to perform initial and serial TACE, and is well-tolerated in patients with HCC and thrombocytopenia. PSE may be a promising treatment option for HCC patients with severe thrombocytopenia associated with splenomegaly who will undergo TACE.

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“…Patients with thrombocytopenia may be ineligible for antiviral treatment or, if able to start therapy, may require a dose reduction or even discontinuation due to the hematological adverse effects. Therefore, splenectomy and partial splenic arterial embolization (PSE) are attracting attention for the treatment of thrombocytopenia with the aim of boosting the efficacy of IFN therapy ( 2 , 3 ). However, the indications for these procedures should be examined carefully only after considering the outcomes of IFN therapy.…”

Section: Introductionmentioning

confidence: 99%

Telaprevir-based triple therapy following partial splenic arterial embolization for chronic hepatitis C with thrombocytopenia can reduce carcinogenesis and improve hepatic function reserve

Ishikawa

Abe

Kojima

et al. 2015

Experimental and Therapeutic Medicine

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Thrombocytopenia in patients with chronic hepatitis C negatively impacts interferon (IFN)-based treatment. The aim of this study was to evaluate the efficacy and safety of telaprevir (TVR)-based triple therapy including IFN for patients who have undergone partial splenic arterial embolization (PSE). Ten patients with thrombocytopenia who were infected with hepatitis C virus (HCV) genotype 1b received 12 weeks of TVR in combination with 24 weeks of pegylated interferon (PEG-IFN)α2b and ribavirin following PSE. A sustained virological response (SVR) was seen in 9 of the 10 patients who could be assessed. Early relapse was seen in 1 patient who had the IL-28B minor allele and a null response to pretreatment. The α-fetoprotein levels of the patients decreased from 17.94±7.30 ng/ml prior to PSE to 4.33±2.41 ng/ml at 6 months after triple therapy (P=0.08). Furthermore, serum albumin levels improved significantly from 3.68±0.49 g/dl pre-PSE to 4.13±0.34 g/dl at 12 months after triple therapy (P=0.043). PSE contributed to the treatment success of triple therapy, particularly for patients who were either treatment-naïve, had a history of relapse or the IL28B major allele. This strategy can reduce carcinogenesis and improve hepatic function reserve.

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Severe thrombocytopenia due to hypersplenism treated with partial splenic embolisation

Cited by 3 publications

References 8 publications

Pancytopenia and Massive Gastroesophageal Bleeding Due to Hypersplenism Treated with Partial Splenic Embolization

Pancytopenia and Massive Gastroesophageal Bleeding Due to Hypersplenism Treated with Partial Splenic Embolization

Long-Term Efficacy and Safety of Partial Splenic Embolization in Hepatocellular Carcinoma Patients with Thrombocytopenia Who Underwent Transarterial Chemoembolization

Telaprevir-based triple therapy following partial splenic arterial embolization for chronic hepatitis C with thrombocytopenia can reduce carcinogenesis and improve hepatic function reserve

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