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β-Blocker therapy ameliorates hypersplenism due to portal hypertension in children

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Abstract

Background/purpose

Thrombocytopenia due to hypersplenism precludes percutaneous liver biopsy in many cases of chronic liver disease (CLD). The aim of this study was to assess the efficacy of propranolol in correcting platelet counts (>100,000/mm3) to ensure percutaneous liver biopsy in children with CLD.

Methods

From January 2005 to December 2012, 51 consecutive children (mean age 11.5 ± 3.0 years, 34 boys) with CLD who needed liver biopsy but could not be done due to hypersplenism-related thrombocytopenia (platelets <100,000/mm3 and/or total leukocyte counts <4,000/mm3 with splenomegaly) were recruited and given a 4-week trial of long-acting propranolol (1.5–2 mg/kg/day). Hemodynamic parameters and splenic artery hemodynamics by Doppler ultrasound were recorded before and after the propranolol trial. Response to therapy was defined as improvement of platelet counts to ≥105/mm3.

Results

Thirty-two (62.7 %) children responded to propranolol therapy and their mean platelet counts increased from 57.5 ± 13.0 × 103 to 140.7 ± 43.3 × 103/mm3, p = 0.0001. Liver biopsy could be done in 29. While comparing responders with non-responders, baseline spleen size (7.4 ± 3.3 vs. 12.7 ± 4.5 cm, p = 0.0001) and platelet counts (57.5 ± 13.0 × 103 vs. 39.5 ± 14.5 × 103, p = 0.0001) were found to be significant. ROC curve suggested a cut-off value of ≤8.5 cm of spleen and ≥53,000 platelets as predictors of response. With propranolol, mean arterial pressure and spleen size reduced (p < 0.05) and splenic artery resistance increased significantly (p = 0.005) in responders.

Conclusions

Propranolol corrects thrombocytopenia and makes liver biopsy possible in almost two-thirds of cases by reducing splenic sequestration through splenic artery vasoconstriction. The baseline spleen size and platelet counts determine the effectiveness of therapy. A trial of β-blocker is worth carrying out in cases where liver biopsy is contraindicated due to hypersplenism-related thrombocytopenia.

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Acknowledgements

We acknowledge the contribution of Dr. Jagadeesh R, Dr. Anuj Thakral, Dr. Madhvi Verma for helping us in facilitating the Doppler study. This paper was presented at the 21st United European Gastroenterology Week (UEGW 2013), Berlin, Germany, October 12–16, 2013.

Compliance with ethical requirements and Conflict of interest

Informed consent was obtained from parents of all participating children. All procedures performed in this study were in accordance with the ethical standards of the institute and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. Ujjal Poddar, Upender Shava, Surender K Yachha, Jaya Agarwal, Sheo Kumar, Sanjay S Baijal, and Anshu Srivastava declare that they have no conflict of interest and ethical standards were maintained in this study.

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Authors and Affiliations

  1. Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, 226014, India

    Ujjal Poddar, Upender Shava, Surender Kumar Yachha, Jaya Agarwal & Anshu Srivastava

  2. Department of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India

    Sheo Kumar & Sanjay S. Baijal

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  1. Ujjal Poddar
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  2. Upender Shava
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Correspondence to Ujjal Poddar.

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Poddar, U., Shava, U., Yachha, S.K. et al. β-Blocker therapy ameliorates hypersplenism due to portal hypertension in children. Hepatol Int 9, 447–453 (2015). https://doi.org/10.1007/s12072-014-9575-z

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