Management of Thrombocytopenia in Advanced Liver Disease

Gangireddy, Venu Gopala Reddy; Kanneganti, Praveen; Sivasubbu, Sridhar; Talla, Swathi; Coleman, Teresa

doi:10.1155/2014/532191

Cited by 50 publications

(49 citation statements)

References 84 publications

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“…Therefore, the rationale selective splenic artery embolization (SSAE) could be a safe and effective alternative to splenectomy for TST patients; nevertheless, few documentations exist about this approach in cirrhotic patients. 30 Gastric varices (GV) are one of the most common complications for patients with portal hypertension. In the majority of cases endoscopic scleroterapy is the option of first choice with significant rate of success.…”

Section: Hypersplenismmentioning

confidence: 99%

Splenectomy in non-traumatic diseases

Gomes¹,

Soares²,

Coccolini³

et al. 2018

AMJ

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Splenectomy represents the first choice for treatment of spontaneous splenic rupture, abscesses, cysts, tumours, and an alternative for control of hereditary, autoimmune, and myeloproliferative disorders. However, its relative indications have been reviewed for better understanding of both the primary affections and of splenectomy per se, particularly with regard to the immune system. The emergence of minimally invasive surgery, the possibility of splenic preservation, and availability of biological therapy has shown that the procedure has often been referred to as salvage therapy upon failure of other therapeutic propositions. On the other hand, patients have their general health status compromised by the underlying disease, by the use corticosteroids or biologic therapy, immunosuppressed, coagulation disorders, which contribute to the incidence of postoperative complications, such as infections, bleeding and venous thrombosis. Therefore, this scenario favours higher morbidity and mortality rates than those of other intra-abdominal surgical procedures. Thus, this review has the primary and comprehensive objective of purpose the best moment for splenectomy, when surgeons can interfere in the natural course of the disease increasing patients' quality of life and survival. In short, it is desired that the surgeon has complete knowledge of the profound physiological changes imposed on the host. In addition, to distinguish when it is curative and mandatory from when it must be put on hold due to other non-operative treatments with similar outcomes and, lastly, when it is not recommended for not aggregating survival. Key Words Splenectomy, splenomegaly, laparoscopyWhat this review adds: What is known about this subject?The indication of splenectomy in trauma patients is wellestablished; however in non-traumatic diseases it is much more controversial and current review and recommendations is scarce. What new information is offered in this review?This review explores the absolute and relative indications for splenectomy in different clinical sets. It also discourses on pathophysiological changes in an already compromised host. What are the implications for research, policy, or practice?Comprehensive review on the role of splenectomy in different non-traumatic settings, especially, haematological diseases in which it represents a rescue therapy because news biologic therapies.

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Section: Hypersplenismmentioning

confidence: 99%

Splenectomy in non-traumatic diseases

Gomes¹,

Soares²,

Coccolini³

et al. 2018

AMJ

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“…Alrededor de un 76%-85% de los pacientes desarrolla algún grado de trombocitopenia (<150 x 10 3 /µL), aunque solo un 13% presenta cifras <50 x 10 3 //µL (23). Cabe recordar que el principal …”

Section: Alteraciones En La Hemostasia Primariaunclassified

“…Se debe tener en cuenta esta comparación al momento de comenzar la valoración del estado hemostático en pacientes con enfermedad hepática, que será realizada al inicio con pruebas rutinarias (como la biometría hemática) y pruebas de coagulación básicas (TT: tiempo de trombina; TP: tiempo de protrombina; INR: international normalized ratio; TTPa: tiempo de tromboplastina parcial activado). Estas pruebas permiten evaluar únicamente los factores procoagulantes (23,36) y, salvo que se tenga una fuerte sospecha de algún defecto congé-nito, se puede complementar la evaluación con determinaciones de los factores de la coagulación (40,61).…”

Section: Valoración De La Hemostasia En Pacientes Hepatópatasunclassified

Insuficiencia hepática crónica y hemostasia

Peñafiel

Sánchez

et al. 2017

Rev. Colomb. Gastroenterol.

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ResumenLa insuficiencia hepática es un estado patológico que condiciona la síntesis y metabolismo de diversas biomoléculas, siendo las alteraciones a la hemostasia una de las primeras consecuencias a nivel sistémico que se hacen presentes; debido a esto y por la dimensión de los riesgos de esta situación, no es raro que las pruebas de coagulación sean indispensables para formular las escalas pronósticas en pacientes hepatópatas.Los conocimientos sobre hemostasia han avanzado en la última década; la clásica cascada de activación de los factores de la coagulación ha sido perfeccionada hasta conformarse el ahora vigente modelo celular que considera la valiosa e indispensable participación del endotelio y las plaquetas. Gracias a esto es posible comprender que, en pacientes con insuficiencia hepática, el riesgo de sangrado no obedece únicamente a la deficiencia en la producción de los factores de la coagulación y, por tanto, es cuestionable la administración de vitamina K. Más relevante aún es que, gracias a estos conocimientos, se puede comprender el a veces contradictorio riesgo de trombosis en estos pacientes, complicación potencialmente mortal. Palabras claveCoagulación sanguínea, insuficiencia hepática, trombosis, vitamina K. AbstractHepatic insufficiency is a pathology that conditions synthesis and metabolism of various biomolecules. Alterations of hemostasis is one of its first systemic consequences. Because of this and the size of the risks, it is not uncommon for clotting tests to be indispensable for formulating prognostic scales in patients with liver disease.Knowledge about hemostasis has advanced in the last decade, and the classic cascade of activation of coagulation factors has been perfected until it has become the now-current cellular model that considers the valuable and indispensable participation of the endothelium and platelets. Thanks to this, it is possible to understand that the risk of bleeding in patients who have hepatic insufficiency is not only due to deficiencies in production of coagulation factors, and that for this reason administration of vitamin K is questionable. Even more relevant, is the fact that, thanks to this this knowledge, we can understand the sometimes contradictory and potentially life-threatening complication of thrombosis in these patients.

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“…Apesar de haver a possibilidade de pacientes com cirrose compensada serem tratados, a resposta destes ao tratamento será mais baixa do que aqueles sem cirrose 37 . Geralmente pacientes com abuso ativo de álcool ou droga ilícita não são tratados até que esse comportamento tenha sido descontinuado a seis meses ou mais, embora 39 . Novas técnicas, como ablação porradiofrequência e estimuladores de TPO, estão sendo investigados para o tratamento de trombopoetina associada a doenças hepáticas 39 .…”

Section: Tratamentounclassified

“…Por mais que agonistas de TPO e agentes alvos sejam instrumentos alternativos não invasivos para o tratamento de trombocitopenia devido a cirrose hepática, suas capacidades de melhorar a primeira condição, ainda estão sobre investigação em ensaios clínicos 39 .…”

Section: Tratamentounclassified