scholarly journals Splenomegaly and thrombocytopenia in patients with liver cirrhosis

2010 ◽  
Vol 67 (2) ◽  
pp. 166-169 ◽  
Author(s):  
Jelena Djordjevic ◽  
Petar Svorcan ◽  
Dusica Vrinic ◽  
Branka Dapcevic
Keyword(s):  
Risk Factors ◽  
Liver Cirrhosis ◽  
Platelet Count ◽  
Portal Hypertension ◽  
Hepatic Dysfunction ◽  
Spleen Size ◽  
Hepatitis Viruses ◽  
Decompensated Liver Cirrhosis ◽  
Splenic Sequestration ◽  
Frequent Finding

Backgroud/Aim. Splenomegaly is a frequent finding in patients with liver cirrhosis and portal hypertension and may cause hypersplenism. The occurrence of thrombocytopenia in those patients can be considered as an event with multiple etiologies. Two mechanisms may act alone or synergistically with splenic sequestration. One is central which involves either myelosuppression because of hepatitis viruses or the toxic effects of alcohol abuse on the bone marrow. The second one involves the presence of antibodies against platelets. It also depends upon the stage and etiology of liver disease. The aim of the study was to investigate a correlation between the platelet count and spleen size and the risk factors for thrombocytopenia in patients with liver cirrhosis. Methods. We studied 40 patients with decompensated liver cirrhosis who were hospitalized in the Department of Gastroenterohepatology. The liver function was graded according to Child Pugh score. Spleen size was defined ultrasonografically on the basis of craniocaudal length. Suspicion of portal hypertension was present when longitudinal spleen length was more than 11 cm. Thrombocytopenia was determined by platelet count under 150 000/mL. Results. We did not find any significant correlation between hepatic dysfunction and spleen size (p = 0.9), and between hepatic dysfunction and thrombocytopenia (p = 0.17). Our study did not find any significant correlation between spleen size and peripheral platelet count (p = 0.5), but we found a significant correlation between thrombocytopenia and etiology of cirrhosis - decreased platelet count was more common among patients with cirrhosis of alcoholic etiology than in other etiologies of cirrhosis (p = 0.001). Conclusion. According to our study, liver cirrhosis, portal hypertension and thrombocytopenia could be present even in the absence of enlarged spleen suggesting the involvement of other mechanisms of decreasing platelet account.

scholarly journals Platelet Count/Splenic Diameter Ratio to Predict Oesophageal Varices in Portal Hypertension

2019 ◽  
Vol 2 (2) ◽  
pp. 192-196
Author(s):  
Buddhi Sagar Lamichhane ◽  
Manoj Koirala ◽  
Bishwo Raj Baral
Keyword(s):  
Liver Cirrhosis ◽  
Platelet Count ◽  
Portal Hypertension ◽  
Esophageal Varices ◽  
Rural Areas ◽  
Predictive Value ◽  
Tertiary Hospital ◽  
Diameter Ratio ◽  
Oesophageal Varices ◽  
Cirrhosis Of Liver

Background: One of the major causes of morbidity and mortality in Nepal is portal hypertension due to liver cirrhosis. In rural areas where a lot of cases of cirrhosis of liver are prevalent and endoscopic expertise and facilities are not available, predicting the presence of esophageal varices through non-invasive means may reduce a large number of unnecessary endoscopies. This study is to identify the relationship of platelet count /splenic bipolar diameter ratio with the presence of esophageal varices in portal hypertension. Materials and methods: Eighty patients were included in this study between Jestha 2072 to Baisakh 2073 with the diagnosis of portal hypertension admitted in Bir hospital, Kathmandu which is a tertiary hospital of government of Nepal, which were mostly due to liver cirrhosis. The patients fulfilling the inclusion criteria underwent lab investigations, ultra sonogram and UGI endoscopy. The data were assessed for descriptive studies and means were compared using t-test. The cut off value of platelet count to spleen diameter ratio of 1150 was used to predict the presence or absence of oesophageal varices. Statistical analysis was done using SPSS 20 software Results: Platelet count to splenic diameter ratio with a cut off value of 1150 has sensitivity of 89.7%, specificity of 83.3%, positive predictive value of 96.8% and negative predictive value of 58.8% (p= 0.002, CI=95%) with 89.5 % accuracy. Conclusion: Platelet count to splenic bipolar diameter ratio can be a good predictor of presence of esophageal varices in patients with portal hypertension in the resource poor settings.

Thrombocytopenia and liver cirrhosis evidence for relationship between platelet count, spleen size and hepatic synthetic activity

1987 ◽  
Vol 45 (3) ◽  
pp. 275-278 ◽  
Author(s):  
F. Marongiu ◽  
A.M. Mamusa ◽  
G. Mameli ◽  
G. Mulas ◽  
A.B. Cambuli ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Platelet Count ◽  
Synthetic Activity ◽  
Spleen Size

scholarly journals Noninvasive Predictors of High-Risk Varices in Patients with Non-Cirrhotic Portal Hypertension

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Morven E. Cunningham ◽  
Gilda Parastandeh-Chehr ◽  
Orlando Cerocchi ◽  
David K. Wong ◽  
Keyur Patel
Keyword(s):  
Platelet Count ◽  
Portal Hypertension ◽  
High Risk ◽  
Primary Outcome ◽  
Liver Stiffness ◽  
Primary Outcome Measure ◽  
Spleen Size ◽  
Liver Stiffness Measurement ◽  
Significant Difference ◽  
Cirrhotic Patients

Non-cirrhotic portal hypertension (NCPH) comprises a heterogeneous group of liver disorders causing portal hypertension without cirrhosis and carries a high risk of variceal bleeding. Recent guidelines, based largely on patients with viral cirrhosis, suggest low likelihood of high risk varices (HRV) in patients with a liver stiffness measurement (LSM) <20 kPa and platelet count >150 × 109/L. In NCPH, LSM is often higher than healthy controls but lower than matched cirrhotic patients. The aim of this study was to assess whether LSM or other noninvasive assessments of portal hypertension could predict HRV in NCPH patients. Methods. Records of patients with NCPH seen at a single centre between 2007 and 2018 were reviewed retrospectively. Primary outcome measure was presence or absence of HRV at gastroscopy within 12 months of clinical assessment. Association of LSM or other clinical features of portal hypertension (spleen size, platelet count, platelet count/spleen length ratio (PSL), LSM-spleen length/platelet count ratio score (LSP)) with HRV and ability of these variables to predict HRV was analysed. Results. Of 44 patients with NCPH who met inclusion criteria, 34% (15/44) had HRV. In a multivariate model, spleen size and PSL correlated with HRV but platelet count, LSM, and LSP did not (spleen size: β = 0.35, p = 0.02; OR 1.42, 95% CI 1.06-1.92; PSL: β = -1.47, p = 0.02; OR 0.23, 95% CI 0.07-0.80). There was no significant difference between spleen size and PSL in predicting HRV (AUROC 0.81 (95% CI 0.66 – 0.91) versus 0.71 (95% CI 0.54 – 0.84), respectively, p = 0.400). Spleen size >17.2cm had sensitivity 78.6% and specificity 64.3% for prediction of HRV. Conclusions. In NCPH patients, spleen size may predict risk of HRV at gastroscopy within 12 months. LSM and platelet count are not useful to assess risk of HRV in NCPH.

scholarly journals Hyaluronic Acid, Spleen Size and Prothrombin Time Predict the Existence of High-Risk Esophageal Varices in Non-Viral Cirrhosis in Real Life

2020 ◽  
Vol 17 (1) ◽  
pp. 7-19
Author(s):  
Silvia Sovaila ◽  
Adrian Purcarea ◽  
Jean Pierre Fauchart ◽  
Dan Gheonea ◽  
Tudorel Ciurea
Keyword(s):  
Platelet Count ◽  
Hyaluronic Acid ◽  
Portal Hypertension ◽  
High Risk ◽  
Prothrombin Time ◽  
Esophageal Varices ◽  
Liver Stiffness ◽  
Real Life ◽  
Spleen Size ◽  
Cirrhotic Patients

AbstractBackground and aims. Biomarkers are a simple and inexpensive way to replace the invasive diagnostic test(1,2). Portal hypertension screening recommendations in cirrhotic patients propose two such biomarkers: the platelet count and liver elastography. This recommendation derives from studies on viral cirrhosis(3). Viral cirrhosis is biologically and histologically different from steatosis related cirrhosis and traditional biomarkers used for high-risk varices screening might not be of use in this category. We aimed to evaluate their utility compared to other biomarkers for the prediction of high-risk varices of non-viral etiology in cirrhotic patients.Methods. Our current study is a monocentric, real-life, cross-sectional analysis of non-viral cirrhosis patients.Results. 50 patients with suspected cirrhosis, who underwent upper gastrointestinal endoscopy, were included prospectively for over 8 months and 41 were analyzed. The etiology was steatohepatitis (alcohol and non-alcohol related steatohepatitis). Hyaluronic acid (AUC 0.866, r =0.600), prothrombin time (AUC 0.708, r =0.445) and spleen size (AUC 0.763, r =0.337) significantly correlated with high-risk esophageal varices. In the meantime, liver stiffness was difficult to obtain and only correlated modestly with high-risk esophageal varices and platelet count was a poor predictor of high-risk esophageal varices in this mainly steatosis related cohort of cirrhotic patients.Conclusion. We proposed hyaluronic acid, spleen size and prothrombin time as alternatives biomarkers for portal hypertension in steatohepatitis patients. Their potency should be further proven in larger studies.

scholarly journals Unsolved issues of pregnancy in liver cirrhosis

2019 ◽  
Vol 91 (4) ◽  
pp. 114-117
Author(s):  
A Iskrenov Kotzev ◽  
L Stoyanov Tanchev ◽  
Ch Savov Pavlov ◽  
S Yotov Tanchev
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Vital Signs ◽  
Abnormal Uterine Bleeding ◽  
Chronic Viral Hepatitis ◽  
Uterine Bleeding ◽  
Variceal Hemorrhage ◽  
Decompensated Liver Cirrhosis ◽  
Viral Hepatitis C ◽  
Life Threatening

Pregnancy in patients with liver cirrhosis and portal hypertension occurs very rare, because of their significantly derailed reproductive functions. Тhe risks for the mother and the fetus are connected with worsening of the portal hypertension, progression of decompensated liver cirrhosis and development of its complications: liver failure, ascites, hepatorenal syndrome, hepatic encephalopathy and variceal hemorrhage, and with increased incidence of spontaneous abortions and abnormal uterine bleeding. The decision for continuation of the pregnancy in cirrhotic patients must be based on individual approach and a multidisciplinary team consisting of obstetricians, hepatologists, anesthesiologists, surgeons and hematologists must participate in the therapy. We are presenting a clinical case with 34 years old pregnant woman with Child-Pugh class C cirrhosis and untreated chronic viral hepatitis C. The patient was admitted in emergency with abortus imminens, vaginal bleeding, anemia, thrombocytopenia and impaired hemostasis. The pregnancy was interrupted in the Department of obstetrics and gynecology due to the high risk for mother’s life. Later the patient developed severe disseminated intravascular coagulation (DIC) syndrome with life-threatening uterine bleeding. The DIC syndrome and the bleeding were resolved after therapy in intensive care unit and the patient was discharged from the hospital with stable vital signs.

scholarly journals SERUM THROMBOPOIETIN LEVELS IN PATIENTS WITH LIVER CIRRHOSIS; RELATION TO SEVERITY OF THE DISEASE, SPLEEN SIZE AND PLATELET COUNT

2003 ◽  
Vol 33 (2) ◽  
pp. 345-365
Author(s):  
Sayed Salem El-Sayed ◽  
Hassan Askalany ◽  
Ehab Abdel-Khalek ◽  
Tarek Amin ◽  
Mohamed Awad ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Platelet Count ◽  
Spleen Size ◽  
Severity Of The Disease

scholarly journals Significance of Non-Invasive Markers as Predictor of Esophageal Varices in Liver Cirrhosis

2017 ◽  
Vol 56 (208) ◽  
pp. 412-6 ◽  
Author(s):  
Dipendra Khadka ◽  
Sushil Prajapati ◽  
Sudhamshu KC ◽  
Jeetendra Kaji Shrestha ◽  
Niyanta Karki ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Platelet Count ◽  
Esophageal Varices ◽  
Complete Blood Count ◽  
Clinical Expertise ◽  
Spleen Size ◽  
Cross Sectional ◽  
Cutoff Value ◽  
Non Invasive ◽  
Pugh Class

Introduction: Upper gastro-intestinal endoscopy remains the gold standard for screening for esophageal varices but it has its own limitations. It is an invasive, expensive and uncomfortable procedure and needs clinical expertise. Accordingly, this study was conducted to establish the role of non-invasive markers for prediction of esophageal varices in liver cirrhosis. Methods: A hospital based descriptive cross-sectional study was carried out in Liver unit of National Academy of Medical Sciences, Bir Hospital, from October 2016 to September 2017. Complete blood count, liver function test, liver ultrasound and upper gastro-intestinal endoscopy were done for all patients to detect esophageal varices and to correlate with different non-invasive markers. Results: Total 191 patients of liver cirrhosis were studied after exclusion. Platelet count of 92082.00±43435.83/mm3 and spleen size of 144.21±10.71 mm was found to be good predictors of presence of EV (P≤0.001). Significant association between Child-Turcotte-Pugh class and presence of varices was observed (P≤0.001). AST/ALT ratio with cutoff value of 1.415 showed sensitivity of 82.4% and specificity of 36.4%. APRI at a cutoff value of 1.3 showed a sensitivity of 83.2% and specificity of 50%. Conclusions: Platelet count, spleen size and Child-Turcotte-Pugh class are good predictors of presence of esophageal varices in patients with liver cirrhosis. AST/ALT ratio and APRI score are not good substitutes for upper gastro-intestinal endoscopy.   Keywords:  esophageal varices; liver cirrhosis; non-invasive markers; portal hypertension; upper gastro-intestinal.

scholarly journals Effect of conventional diuretics versus conventional diuretics plus mannitol on electrolytes for the treatment of cirrhotic ascites

2016 ◽  
Vol 45 (2) ◽  
pp. 90-93
Author(s):  
Md Jamshed Alam ◽  
Mohammad Shahed Ashraf ◽  
Mst Nurunnahar Aktar ◽  
Sadia Sharmin ◽  
Dulal Chandra Das ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Case Control Study ◽  
Case Control ◽  
Electrolyte Imbalance ◽  
Urinary Volume ◽  
Decompensated Liver Cirrhosis ◽  
Medical College ◽  
Frequent Finding ◽  
Control Study

Ascites is the most frequent finding of decompensated liver cirrhosis. Mannitol may be used with conventional diuretics for increase urinary volume for the treatment of cirrhotic ascites. This case control study was done in the Department of Medicine, Sere-Bangla Medical College &Hospital, Barisal from July 2009 to June 2011. No electrolyte imbalance was seen by conventional diuretics plus mannitol for the treatment of cirrhotic ascites. Mannitol did not causee lectrolyte imbalance & may be used with conventional diuretics for the treatment of cirrhotic ascites as it increased the urinary volume.Bangladesh Med J. 2016 May; 45 (2): 90-93

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