Essential thrombocythemia with portal vein thrombosis and splenic infarction successfully treated with platelet apheresis

2021 ◽  
Vol 14 (9) ◽  
pp. e245267
Author(s):  
Ami Mehul Mehta ◽  
Shubha Seshadri ◽  
Seemitr Verma ◽  
Sharath P Madhyastha
Keyword(s):  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Essential Thrombocythemia ◽  
Splenic Infarction ◽  
High Rate ◽  
Diabetic Woman ◽  
Complete Evaluation ◽  
Vein Thrombosis ◽  
History Of ◽  
High Platelet Count

A 63-year-old diabetic woman presented to the outpatient clinic with a 1-week history of abdominal pain. On complete evaluation, she was diagnosed to have essential thrombocythemia. Abdominal imaging revealed portal vein thrombosis with a large splenic infarct. The patient was started on anticoagulant, antiplatelet and cytoreductive therapy. In view of persistent high platelet count, plasma apheresis was done, following which the patient’s platelet counts were reduced. Essential thrombocythemia has a high rate of complications, resulting in significant morbidity and mortality. Few cases of this disease and its treatment have been described in the literature, especially pertaining to the Indian scenario. Further studies are needed to establish a multidisciplinary algorithm for its diagnosis and to elucidate the guidelines for the successful treatment of the condition.

scholarly journals Low Molecular Weight Heparin in Portal Vein Thrombosis of Cirrhotic Patients: Only Therapeutic Purposes?

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Raffaele Licinio ◽  
Mariabeatrice Principi ◽  
Giuseppe Losurdo ◽  
Nicola Maurizio Castellaneta ◽  
Enzo Ierardi ◽  
...  
Keyword(s):  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
High Rate ◽  
Low Molecular Weight ◽  
Vein Thrombosis ◽  
If Current ◽  
General Feeling ◽  
Cirrhotic Patients ◽  
Current Guidelines ◽  
Hepatic Synthesis

Cirrhosis has always been regarded as hemorrhagic coagulopathy caused by the reduction in the hepatic synthesis of procoagulant proteins. However, with the progression of liver disease, the cirrhotic patient undergoes a high rate of thrombotic phenomena in the portal venous system. Although the progression of liver failure produces a reduction in the synthesis of anticoagulant molecules, a test able to detect the patients with hemostatic balance shifting towards hypercoagulability has not yet been elaborated. The need of treatment and/or prophylaxis of cirrhotic patients is demonstrated by the increased mortality, the risk of bleeding from esophageal varices, and the mortality of liver transplantation, when portal vein thrombosis (PVT) occurs even if current guidelines do not give indications about PVT treatment in cirrhosis. In view of the general feeling that the majority of cirrhotic patients at an advanced stage may be in a procoagulant condition (suggested by the sharp increase in the prevalence of PVT), it is presumable that a prophylaxis of this population could be of benefit. The safety and the efficacy of prophylaxis and treatment with enoxaparin in patients with cirrhosis demonstrated by a single paper suggest this option only in controlled trials and, currently, there are no sufficient evidences for a recommendation in the clinical practice.

Inherited thrombophilic abnormalities and risk of portal vein thrombosis

2008 ◽  
Vol 99 (04) ◽  
pp. 675-682 ◽  
Author(s):  
Matteo Galli ◽  
Monica Gianni ◽  
Walter Ageno ◽  
Francesco Dentali
Keyword(s):  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Western Europe ◽  
Sensitivity Analyses ◽  
Cochrane Library ◽  
Vein Thrombosis ◽  
Statistical Heterogeneity ◽  
Fixed And Random Effects ◽  
Study Characteristics ◽  
History Of

SummaryInherited thrombophilic abnormalities may have a role in the development of portal vein thrombosis (PVT).However, the prevalence of these factors in patients with PVT has been evaluated only in small studies with non-conclusive results. It was the purpose of this study to assess the risk of PVT associated with factorV Leiden (FVL) and G20210A prothrombin mutation (PTM). The MEDLINE, EMBASE, Cochrane Library databases, reference lists of retrieved articles and contact with content experts were used. Studies carried out in Western Europe comparing the prevalence of prothrombotic abnormalities in patients with PVT and in controls without a history of thromboembolic disease were included. Two reviewers independently selected studies and extracted study characteristics, quality and outcomes. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for each trial and pooled using a fixed and random-effects model. Statistical heterogeneity was evaluated using the I2 statistic. Sensitivity analyses were performed examining separately studies according to the etiology of PVT and to control population. Twelve studies involving more than 3,000 patients were included. The pooled OR for PVT was 1.90 (95%CI: 1.25, 2.90) in patients with FVL and 4.48 (95%CI: 3.10, 6.48) in patients with PTM. In conclusion, PVT is associated with the presence of FVL and PTM in Western Europe.

scholarly journals Risk Factors Regarding Portal Vein Thrombosis in Chronic Liver Disease

2020 ◽  
Vol 25 (4) ◽  
pp. 38-41
Author(s):  
Liliana Vecerzan ◽  
Romeo Gabriel Mihăilă
Keyword(s):  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Hepatic Cirrhosis ◽  
Vascular Diseases ◽  
High Rate ◽  
Imaging Method ◽  
Vein Thrombosis ◽  
Common Causes ◽  
Portosystemic Collateral ◽  
Collateral Vessels

Abstract The portal vein thrombosis (PVT) is one of the most frequent vascular diseases of the liver, with a high rate of morbidity and mortality. The most common causes of the PVT are hepatic cirrhosis, hepatobiliary neoplasms, inflammatory and infectious abdominal diseases, and myeloproliferative syndromes.(1,2) The natural progress of the PVT has as a result portal hypertension which leads to splenomegaly and the formation of portosystemic collateral vessels, as well as gastroesophageal, duodenal and jejunal varices. Ultrasonography, especially Doppler ultrasound, is the most widely used imaging method to asses, supervise and diagnose PVT in patients with hepatopathies. The purpose of acute PVT treatment is to re-permeabilize the obstructed vessels; the endoscopic ligature of the varices in the eventuality of their rupture is safe and extremely efficient in chronic PVT. To conclude, PVT is the most common hepatic vascular disorder, and its prevalence has increased particularly among the patients with chronic hepatopathies.(3)

Non tumoral portal vein thrombosis during cirrhosis: Should anticoagulation be proposed?

2018 ◽  
Keyword(s):  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Anticoagulant Therapy ◽  
Control Group ◽  
Case Group ◽  
Early Introduction ◽  
Vein Thrombosis ◽  
History Of ◽  
One Year ◽  
The Impact

Background: Portal vein thrombosis (PVT) is considered as infrequent and pejorative event in cirrhosis. Up to date, many questions remain about therapeutic management. Aim: The objectives of this study were to assess the impact of the PVT on the progression of liver disease, to review the indications for anticoagulation and its repercussions. Materials and methods: A case-control study was conducted over a period of 12 years (2002-2013). It included 484 cases of cirrhosis. Among these patients, 41 had non tumoral portal vein thrombosis (case group). The control group included the remaining 443 patients. Results: In our study, there was no impact of PVT on the natural history of cirrhosis both in terms of complications or survival. Only the early introduction of anticoagulant therapy was associated with a re-permeabilization of portal vein at one year (OR1.6; 95% CI [1.10-2.01]). Prolonged anticoagulation was inversely correlated with recurrent PVT after treatment. However, obtaining a portal vein re-permeabilization was not correlated to a significant gain in terms of prevention of complication related to cirrhosis and survival. Conclusions: results suggest that portal vein thrombosis in patients with cirrhosis is not a formal indication for anticoagulant therapy. It should be reserved for candidates of liver transplantation, those with an extension of the PVT to mesenteric vessels or with severe prothrombotic status. Key words: portal vein thrombosis, cirrhosis, anticoagulation.

scholarly journals Porta hepatis abscess and portal vein thrombosis following ingestion of a fishbone

2019 ◽  
Vol 12 (4) ◽  
pp. e227271 ◽  
Author(s):  
Brittany Greene ◽  
Daniel Jones ◽  
Josée Sarrazin ◽  
Natalie G Coburn
Keyword(s):  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Gastric Perforation ◽  
Exploratory Laparotomy ◽  
Porta Hepatis ◽  
Surgical Exploration ◽  
Vein Thrombosis ◽  
History Of ◽  
Serial Ct ◽  
Upper Abdomen

A man in his late 50s presented to the emergency room with a 1-month history of severe abdominal pain and an endoscopic fishbone retrieval from his rectum. Serial CT scans revealed a fishbone located in the patient’s upper abdomen, which had migrated through the stomach wall, into the periportal space, causing a contained gastric perforation, development of a porta hepatis abscess and secondary portal vein thrombosis. Furthermore, the sharp tip of the fishbone lay 5 mm from the patient’s hepatic artery. He was transferred to a hepatobiliary centre where he underwent urgent exploratory laparotomy, with surgical exploration of the porta, drainage of the abscess and retrieval of the fishbone. Postoperatively, he received further treatment with antibiotics and anticoagulation and recovered without further sequelae.

scholarly journals Unhappy Triad: Infection with Leptospira spp. Escherichia coli and Bacteroides uniformis Associated with an Unusual Manifestation of Portal Vein Thrombosis

2021 ◽  
pp. 598-602
Author(s):  
Sven Kalbitz ◽  
Jörg Ermisch ◽  
Jonathan M. Schmidt ◽  
Ingo Wallstabe ◽  
Christoph Lübbert
Keyword(s):  
Escherichia Coli ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Anticoagulation Therapy ◽  
Intestinal Bacteria ◽  
Recurrent Fever ◽  
Coagulation Disorder ◽  
Vein Thrombosis ◽  
Atypical Manifestations ◽  
History Of

Portal vein thrombosis (PVT) is a rare disease with an incidence of 0.7/100,000 inhabitants per year. Septic PVT (pylephlebitis) usually occurs secondary to infection in the anatomic region drained by the portal venous system. We report on a 76-year-old German male who was admitted with a history of recurrent fever and acute renal failure. Blood cultures taken on admission showed <i>Escherichia coli</i>, as well as <i>Bacteroides uniformis</i> after an extended incubation period of 90 h. In addition, infection with <i>Leptospira</i> spp. was diagnosed serologically. Computerized tomography of the abdomen revealed an extensive PVT along with signs of colonic diverticulitis. Symptoms resolved under prolonged antimicrobial therapy with beta-lactams and adequate heparinization. A myeloproliferative disorder could be excluded. There was no evidence of an underlying coagulation disorder. Imaging controls showed an almost complete resolution of the PVT after 6 months of anticoagulation therapy. To the best of our knowledge, this is the first report of such an “unhappy triad,” which includes atypical manifestations of leptospirosis and involvement of other intestinal bacteria.

Sign in / Sign up

Export Citation Format

Share Document