Splenomegaly, hypersplenism and coagulation abnormalities in liver disease

McCormick, Peter; Murphy, Karen

doi:10.1053/bega.2000.0144

Cited by 125 publications

(111 citation statements)

References 85 publications

Supporting

Mentioning

106

Contrasting

Unclassified

Order By: Relevance

“…In patients with chronic liver disease, serum thrombopoietin levels have been reported to be low, normal or elevated in the presence of thrombocytopenia. 10,12 …”

Section: 24mentioning

confidence: 99%

Chronic hepatitis C-associated thrombocytopenia: aetiology and management

Fouad

2013

View full text Add to dashboard Cite

Thrombocytopenia is perhaps the most common haematological abnormality in patients with chronic hepatitis C virus (HCV) infection. In these patients, the presence of thrombocytopenia may be a limiting factor when considering antiviral therapy and may be associated with decreased sustained virological response rates. Thrombocytopenia may interfere with diagnostic procedures such as liver biopsy, because of risk of bleeding.Pathogenetic mechanisms include hypersplenism secondary to portal hypertension, bone marrow suppression resulting from either HCV itself or interferon treatment, and aberrations of the immune system resulting in the formation of anti-platelet antibodies and/or immunecomplexes that bind to platelets and facilitate their premature clearance. The ability to increase platelet levels could significantly reduce the need for platelet transfusions and facilitate the use of interferon-based antiviral therapy and other medically indicated treatments in patients with liver disease. Therapeutic options include pharmacological and non-pharmacological therapies. This review summarizes the available data on these therapeutic options. KEYWORDS: thrombocytopenia, hepatitis C virus (HCV), cytokines Definition and prevalenceThrombocytopenia has been defined as a platelet count <150,000 cells/µL. In a recent systematic review, the definitions of thrombocytopenia varied between studies and were based either on platelet counts, with threshold levels ranging between <100,000 cells/µL and <180,000 cells/µL or on criteria set in haematological guidelines. The prevalence of thrombocytopenia related to chronic liver disease has been reported as 15% to 70% in patients with advanced fibrosis and portal hypertension, depending on the stage of the disease and the platelet level used to define thrombocytopenia. In patients with chronic HCV infection, the prevalence of thrombocytopenia ranged from 0.16% to 45.4% and more than half of the studies reported a prevalence of 24% or more. 1 Aetiology of thrombocytopenia in patients with chronic HCVThe pathophysiology of thrombocytopenia in patients with HCV-related chronic liver disease is complex and involves the interaction of multiple factors. In general, these factors may be

show abstract

“…In patients with chronic liver disease, serum thrombopoietin levels have been reported to be low, normal or elevated in the presence of thrombocytopenia. 10,12 …”

Section: 24mentioning

confidence: 99%

Chronic hepatitis C-associated thrombocytopenia: aetiology and management

Fouad

2013

View full text Add to dashboard Cite

show abstract

“…While splenectomy is an effective treatment of splenomegaly in the setting of cirrhosis, it is not without risk [4] . Major complications include portal vein thrombosis and sepsis [4,5] . Additionally, some cirrhotic patients may be poor surgical candidates, thus necessitating alternative approaches to splenomegaly amongst some cirrhotic patients.…”

Section: Introductionmentioning

confidence: 99%

Partial splenic artery embolization in cirrhotic patients

Hadduck¹,

McWilliams²

2014

WJR

View full text Add to dashboard Cite

Splenomegaly is a common sequela of cirrhosis, and is frequently associated with decreased hematologic indices including thrombocytopenia and leukopenia. Partial splenic artery embolization (PSE) has been demonstrated to effectively increase hematologic indices in cirrhotic patients with splenomegaly. This is particularly valuable amongst those cirrhotic patients who are not viable candidates for splenectomy. Although PSE was originally developed decades ago, it has recently received increased attention. Presently, PSE is being utilized to address a number of clinical concerns in the setting of cirrhosis, including: decreased hematologic indices, portal hypertension and its associated sequela, and splenic artery steal syndrome. Following PSE patients demonstrate significant increases in platelets and leukocytes. Though progressive decline of hematologic indices occur following PSE, they remain improved as compared to pre-procedural values over long-term follow-up. PSE, however, is not without risk and complications of the procedure may occur. The most common complication of PSE is post-embolization syndrome, which involves a constellation of symptoms including fever, pain, and nausea/vomiting. The rate of complications has been shown to increase as the percent of total splenic volume embolized increases. The purpose of this review is to explore the current literature in regards to PSE in cirrhotic patients and to highlight their techniques, and statistically summarize their results and associated complications. Key words: Partial splenic embolization; Cirrhosis; Liver disease; Thrombocytopenia; Leukopenia Core tip: Splenomegaly is a common sequela of cirrhosis, and is frequently associated with decreased hematologic indices including thrombocytopenia and leukopenia. Partial splenic artery embolization (PSE) has been demonstrated to effectively increase hematologic indices in cirrhotic patients with splenomegaly. This is particularly valuable amongst cirrhotic patients that are not viable candidates for splenectomy. Although PSE was originally developed decades ago, it has recently received increased attention. Presently, PSE is being utilized to address a number of clinical concerns in the setting of cirrhosis, including: decreased hematologic indices, portal hypertension and its associated sequela, and splenic artery steal syndrome.Hadduck TA, McWilliams JP. Partial splenic artery embolization in cirrhotic patients. World J Radiol 2014; 6(5): 160-168 Available from:

show abstract

“…It has been mainly attributed to the sequestration of platelets by an enlarged spleen due to portal hypertension which is named as ''hypersplenism'' [1]. Mechanisms other than hypersplenism such as reduced thrombopoetin or bone marrow suppression also contribute this thrombocytopenia [2].…”

Section: To the Editormentioning

confidence: 99%