Change in platelet count in patients with hypersplenism subjected to liver transplantation / Modificação no número de plaquetas de pacientes com hiperesplenismo submetidos a transplante hepático

CONTEXT: Most patients subjected to liver transplantation presents hypersplenism, which is reversed after the operation. However, some patients remain with moderate to intense hypersplenism. OBJECTIVES: To study the effect of liver transplantation on platelet count in patients with hypersplenism. METHOD: Of a total of 233 patients who underwent liver transplantation, 162 were excluded from the present study because of occurrence of steroid-resistant rejection, absence of hypersplenism before the transplantation, absence of follow-up for at least 2 years or incomplete exams data. The electronic study protocols of the remaining 71 patients were reviewed to determine the demographics, etiology of cirrhosis, and results of pathologic examination of the explanted liver. Serial platelet count was obtained from the study protocol on the day before liver transplantation and 1, 2, 4, and 6 months and 1 year after liver transplantation. Statistical analysis was performed using the Student's t-test, chi-square test, and Spearman's correlation test. RESULTS: Posttransplant platelet count at all time intervals was significantly higher than the pretransplant value (P<0.001 for all time intervals). Thrombocytopenia was reversed (platelet count >100,000/mm³) in 58 patients (81.7 percent) 1 month after liver transplantation. Twelve patients (16.9 percent) remained with thrombocytopenia 1 year after liver transplantation. Three patients (4.2 percent) had recurrence of thrombocytopenia within 1 year after liver transplantation. There was no correlation between pretransplant platelet count and the Child-Pugh class or the MELD score. CONCLUSION: Liver transplantation reverses hypersplenism in most patients.

CONTEXTO: A maioria dos pacientes submetidos a transplante hepático apresenta hiperesplenismo, que é revertido após a operação. Entretanto, alguns pacientes permanecem com hiperesplenismo moderado a intenso. OBJETIVO: Avaliar o efeito do transplante hepático na contagem de plaquetas de pacientes com hiperesplenismo. MÉTODOS: De um total de 233 pacientes que foram submetidos a transplante hepático, 162 foram excluídos do presente estudo devido à ocorrência de rejeição resistente a corticóide, ausência de hiperesplenismo antes do transplante, ausência de seguimento pós-transplante por pelos menos 2 anos ou dados de exames incompletos. O protocolo eletrônico de estudo dos demais 71 pacientes foi revisado para determinar os aspectos demográficos, a etiologia da cirrose e o resultado do exame patológico do fígado explantado. Contagem seriada de plaquetas foi obtida do protocolo de estudo no dia antes do transplante e 1, 2, 4 e 6 meses e 1 ano após o transplante. Análise estatística foi realizada empregando o teste t de Student, o teste qui ao quadrado e o teste de correlação de Spearman. RESULTADOS: A contagem de plaquetas pós-transplante em todos os intervalos de tempo foi significantemente maior que os valores pré-transplantes (P<0,001 para rodos os intervalos de tempo). Trombocitopenia foi revertida (contagem de plaquetas >100.000/mm³) em 58 pacientes (81,7 por cento) 1 mês após o transplante. Doze pacientes (16,9 por cento) permaneceram com trombocitopenia 1 ano após o transplante. Três pacientes (4,2 por cento) tiveram recurrência da trombocitopenia dentro de 1 ano após o transplante. Não houve correlação entre a contagem de plaquetas pré-transplante e a classe de Child-Pugh e o escore de MELD. CONCLUSÃO: O transplante hepático reverte o hiperesplenismo na maioria dos pacientes.

The Role of Splenectomy in Patients with Hepatocellular Carcinoma and Secondary Hypersplenism

Hypersplenism, secondary to portal hypertension, is common in hepatocellular carcinoma (HCC) with liver cirrhosis. Hepatic resection in the patient with hypersplenic thrombocytopenia (HSTC) may cause a perioperative bleeding episode and sometimes, liver failure. In order to investigate the effect of concomitant splenectomy in HCC patients with HSTC, clinical parameters are retrospectively reviewed for 18 HCC patients who underwent hepatic resection with or without splenectomy. Among 581 HCC patients who underwent hepatic resection during the past 17 years, 18 patients with HSTC were investigated. Twelve of them underwent hepatic resection for HCC and had a concomitant splenectomy and the remaining 6 patients underwent hepatic resection for HCC only. The clinical outcomes and postoperative changes in platelet count, serum albumin level, serum total bilirubin levels, prothrombin time and clinical staging (Child-Pugh Classification) were reviewed. The resected spleen mean weight was 350.7+/-102.9 g. Postoperative platelet counts were significantly increased with albumin levels and clinical staging scores also improved after the splenectomy. Among the 12 patients who had a splenectomy, 6 patients had postoperative complications and one died of recurrent variceal bleeding. According to this data, it is not harmful to perform a concomitant splenectomy and hepatectomy for the HCC patient with severe HSTC, it can even be beneficial in improving both the platelet count and clinical staging.

Recurrent splenic sequestration in a Kuwaiti boy with sickle cell disease

Children suffering from sickle cell disease are susceptible to different types of crises, such as acute vaso-occlusive, haemolytic, aplastic and sequestration crises. The classic acute sequestration crisis is a serious condition usually affecting black children, in which large amounts of blood are suddenly pooled into the spleen. The spleen suddenly enlarges markedly and signs of circulatory collapse rapidly develop, leading to death unless an emergency splenectomy is performed. Minor recurrent sequestration episodes have been recently reported in patients with sickle cell disease and a high fetal haemoglobin concentration. These episodes are of a milder presentation and outcome can be managed with repeated blood transfusions and later, elective splenectomy In this case report, we describe an Arab Kuwaiti boy with recurrent splenic sequestration who was treated with elective splenectomy, and propose a policy for the management of such patients

Visceral leishmaniasis among hypersplenic patients in Dakahlia governorate, Egypt

In the present study, out of 22 human cases with hypersplenism and suggesting manifestations, four gave seropositivity for VL by the indirect hemagglutination tests [128 and more]. Two of these four patients gave seropositivity by dot-ELISA [1: 8000]. Amastigotes of Leishmania parasite were demonstrated in the splenic smears obtained during splenectomy. One culture obtained from these two cases grew promastigotes. Typing is ongoing. It was concluded that visceral leishmaniasis should be considered in the differential diagnosis of patients with hepatosplenomegaly or hypersplenism in Egypt

Skeletal manifestations in beta-thalassaemia intermedia.

Thalassaemia intermedia with distressing complications is reported from India. An 11 year old boy presented with recurrent fractures since 6 years of age. Investigations revealed that he had multiple healed fractures of long bones, hypersplenism, iron overload and a red blood cell half life (t1/2) of 17 1/2 days. Splenectomy was planned.

Influência de anticorpos sobre a evoluçäo da doença esquistossomótica com hiperesplenismo / Antibodies influence on the evolution of schistosomiasis with hyperesplenism

Os autores apresentam um caso clínico de esquistossomose com hiperesplenismo onde o anticorpo humoral a frio, IgM, interferiu na evoluçäo clínica da doença. A esplenomegalia, o hiperesplenismo e a eletroforese de proteínas foram analisadas nos comentários. A funçäo hepatocelular mostrou-se normal como também foram normais a avaliaçäo pulmonar, a espirometria, a hemogasimetria, a semiologia e a radiologia torácica. O coagulograma evidenciou alteraçäo do tempo de protrombina, da tromboplastina ativada e da lise de euglobulina. O fibrinogênio e a fibrina séricas foram normais. Testes de Coombs indiretos a frio evidenciaram anticorpo tipo IgM. A identificaçäo de anticorpos feita por um painel de hemácias demonstrou para os diversos antígenos utilizados apenas anti-l positivo. O antígeno i evidenciado pelos testes poderia interferir com os títulos de Ag l resultando elevaçäo de anticorpos IgM pela resposta humoral anômala. Os anticorpos IgM possuem sítios de ligaçäo com as hemácias, que provavelmente desencadeariam ativaçäo do complemento com lise das mesmas. As fraçöes séricas complementares desviadas para essas funçöes prejudicariam, possivelmente, o fenômeno de coagulaçäo sangüínea. O retardo originado da atividade de protrombina para trombina poderia ser explicado pelo desvio da funçäo dos componentes do complemento ativado pelo anticorpo IgM, apesar do uso intramuscular prolongado de vitamina K. A esplenomegalia seria a provável responsável pelo fato assinalado, pois, na evoluçäo pós-esplenectomia tais açöes desapareceram sobre a coagulaçäo, apesar da persistência do anticorpo na doente