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 1 publication

(2 citation statements)

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“…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%

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Causes of peripheral cytopenia in hepatitic cirrhosis and portal hypertensive splenomegaly

Lau

et al. 2017

Exp Biol Med (Maywood)

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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.

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Section: Discussionmentioning

confidence: 99%