Eighty-five patients with chronic splenomegaly and proven oesophageal varices were studied at Kenyatta National Hospital, Nairobi. The major defined groups were hepatosplenic schistosomiasis (24%), cirrhosis (20%) and portal vein occlusion (11%). Hyper-reactive malarial splenomegaly (tropical splenomegaly syndrome) was considered as the cause of oesophageal varices in only one patient. In 26% of cases liver biopsy was non-diagnostic and the extrahepatic portal vein was demonstrated radiologically to be patent. Such patients were thought to be suffering from idiopathic portal hypertension, not previously described elsewhere in Africa. Hepatitis B surface antigen was detected in 12% of controls and in 58% of patients with cirrhosis (p less than 0.001). Some serological marker of previous hepatitis B virus infection was present in 92% of patients with cirrhosis and in 79% of controls. Kamba patients from Machakos and Kitui Districts were significantly more prevalent than expected among these 85 cases of portal hypertension.

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BACKGROUNDLiver plays a major role in maintaining the haematological parameters in normal and maintain the haemostasis. Liver is the storage site for iron, B12 and folic acid, which are necessary for the normal haematopoiesis. Liver also secretes the clotting factors and the inhibitors and keep the haemostasis in equilibrium. Hepatocellular failure, portal hypertension and jaundice may affect the blood picture. Chronic liver disease is usually accompanied by hypersplenism. Diminished erythrocyte survival is frequent. In addition, both parenchymal hepatic disease and cholestatic jaundice may produce blood coagulation defects. Dietary deficiencies, alcoholism, bleeding and difficulties in hepatic synthesis of proteins used in blood formation or coagulation add to complexity of the problem.