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Portal hypertension and hypersplenism in extrahepatic portal venous obstruction: Are they related?

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Abstract

Background and Aims

Portal hypertension (PHT) due to extrahepatic portal venous obstruction (EHPVO) is common in developing countries. Hypersplenism is a near-constant feature of EHPVO, but its significance, unlike in cirrhotics, is unknown. We aimed to study the relationship between hypersplenism and the severity of PHT in patients with EHPVO.

Methods

This prospective study was done at a tertiary care center from January 2014 to August 2015. All patients with EHPVO who underwent a splenectomy and a shunt or devascularization were included. Data regarding clinical profile, preoperative parameters, and intraoperative details were recorded. The correlation was studied between hypersplenism and the intraoperatively measured portal pressures and markers of PHT.

Results

Of the 40 patients studied (mean [SD] age 22.4 [8.4] years), hematological hypersplenism was present in 39 (97.5%). The mean (SD) hemoglobin, total leukocyte counts (TLC), and platelet counts were 9.9 (2.4) g/dL, 2971 (1239) cells/mm3, and 66,400 (32047) cells/mm3, respectively. The mean (SD) sonographic spleen volume (SV), splenic weight, and intraoperative portal pressure were 1084.7 (553.9) cm3, 1088.7 (454.7) g, and 35.6 (5.1) mmHg, respectively. The TLC and platelet counts correlated inversely with the portal pressure. Additionally, the platelet counts correlated negatively with eradicated variceal status, SV, and weight; hemoglobin with SV and weight; and TLC with SV. Multivariate analysis showed the platelet counts were an independent predictor of portal pressures and platelet counts ≤ 53,500 cells/mm3 indicated significantly high portal pressures.

Conclusions

The platelet counts showed a significant inverse correlation with portal pressures in patients with EHPVO and may be used as surrogate markers of PHT. A platelet count ≤ 53,500 cells/mm3 is predictive of significantly high pressures.

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References

  1. Anand CS, Tandon BN, Nundy S. The causes, management and outcome of upper gastrointestinal haemorrhage in an Indian hospital. Br J Surg. 1983;70:209–11.

    Article  PubMed  CAS  Google Scholar 

  2. Sarin SK, Sollano JD, Chawla YK, et al. Consensus on extra-hepatic portal vein obstruction. Liver Int. 2006;26:512–9.

  3. Basu A. Surgical management of juvenile portal hypertension. Proc. 37th Int. Paediatr. Congr. 1977, New Delhi, India; 1977.

  4. Shah SR, Mathur SK. Presentation and natural history of variceal bleeding in patients with portal hypertension due to extrahepatic portal venous obstruction. Indian J Gastroenterol. 2003;22:217–20.

    PubMed  Google Scholar 

  5. Webb LJ, Sherlock S. The aetiology, presentation and natural history of extra-hepatic portal venous obstruction. Q J Med. 1979;48:627–39.

    PubMed  CAS  Google Scholar 

  6. Naik SR, Bambery P, Tyagi SK, Datta DV, Koshy A. Blood counts in portal hypertension of non-cirrhotic origin: correlation with splenic size and splenic pulp pressure. Indian J Gastroenterol. 1986;5:15–6.

    PubMed  CAS  Google Scholar 

  7. Shah SH, Hayes PC, Allan PL, Nicoll J, Finlayson ND. Measurement of spleen size and its relation to hypersplenism and portal hemodynamics in portal hypertension due to hepatic cirrhosis. Am J Gastroenterol. 1996;91:2580–3.

    PubMed  CAS  Google Scholar 

  8. Lee E, Kim YJ, Goo DE, et al. Comparison of hepatic venous pressure gradient and endoscopic grading of esophageal varices. World J Gastroenterol. 2016;22:3212–9.

  9. Silkauskaite V, Pranculis A, Mitraite D, Jonaitis L, Petrenkiene V, Kupcinskas L. Hepatic venous pressure gradient measurement in patients with liver cirrhosis: a correlation with disease severity and variceal bleeding. Med Kaunas Lith. 2009;45:8–13.

    Google Scholar 

  10. Piscaglia F, Donati G, Cecilioni L, et al. Influence of the spleen on portal haemodynamics: a non-invasive study with Doppler ultrasound in chronic liver disease and haematological disorders. Scand J Gastroenterol. 2002;37:1220–7.

  11. Alcantara RV, Yamada RM, De Tommaso AMA, Bellomo-Brandão MA, Hessel G. Non-invasive predictors of esophageous varices in children and adolescents with chronic liver disease or extrahepatic portal venous obstruction. J Pediatr 2012;88:341–6.

  12. Ying L, Lin X, Xie Z-L, Hu Y-P, Shi K-Q. Performance of platelet count/spleen diameter ratio for diagnosis of esophageal varices in cirrhosis: a meta-analysis. Dig Dis Sci. 2012;57:1672–81.

    Article  PubMed  Google Scholar 

  13. Latorre R, Vaquero J, Rincón D, et al. Determinants of platelet count are different in patients with compensated and decompensated cirrhosis. Liver Int. 2016;36:232–9.

    Article  PubMed  CAS  Google Scholar 

  14. Liangpunsakul S, Ulmer BJ, Chalasani N. Predictors and implications of severe hypersplenism in patients with cirrhosis. Am J Med Sci. 2003;326:111–6.

    Article  PubMed  Google Scholar 

  15. Singh IK, Bhatnagar V, Gupta AK, Seith A. Correlation of splenic volume with hematological parameters, splenic vein diameter, portal pressure and grade of varices in extrahepatic portal vein obstruction in children. Pediatr Surg Int. 2011;27:467–71.

    Article  PubMed  Google Scholar 

  16. Elstein D, Hadas-Halpern I, Azuri Y, Abrahamov A, Bar-Ziv Y, Zimran A. Accuracy of ultrasonography in assessing spleen and liver size in patients with Gaucher disease: comparison to computed tomographic measurements. J Ultrasound Med. 1997;16:209–11.

    Article  PubMed  CAS  Google Scholar 

  17. Gielchinsky Y, Elstein D, Hadas-Halpern I, Lahad A, Abrahamov A, Zimran A. Is there a correlation between degree of splenomegaly, symptoms and hypersplenism? A study of 218 patients with Gaucher disease. Br J Haematol. 1999;106:812–6.

    Article  PubMed  CAS  Google Scholar 

  18. Prasad AS, Gupta S, Kohli V, Pande GK, Sahni P, Nundy S. Proximal splenorenal shunts for extrahepatic portal venous obstruction in children. Ann Surg. 1994;219:193–6.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  19. Weiss B, Shteyer E, Vivante A, et al. Etiology and long-term outcome of extrahepatic portal vein obstruction in children. World J Gastroenterol. 2010;16:4968–72.

  20. Thomas V, Jose T, Kumar S. Natural history of bleeding after esophageal variceal eradication in patients with extrahepatic portal venous obstruction; a 20-year follow-up. Indian J Gastroenterol. 2009;28:206–11.

    Article  PubMed  Google Scholar 

  21. Sarin SK, Agarwal SR. Extrahepatic portal vein obstruction. Semin Liver Dis. 2002;22:43–58.

    Article  PubMed  Google Scholar 

  22. Sarin SK, Bansal A, Sasan S, Nigam A. Portal-vein obstruction in children leads to growth retardation. Hepatology. 1992;15:229–33.

    Article  PubMed  CAS  Google Scholar 

  23. Rajalingam R, Javed A, Sharma D, et al. Management of hypersplenism in non-cirrhotic portal hypertension: a surgical series. Hepatobiliary Pancreat Dis Int. 2012;11:165–71.

  24. Mitra SK, Kumar V, Datta DV, et al. Extrahepatic portal hypertension: a review of 70 cases. J Pediatr Surg. 1978;13:51–7.

  25. Sharma BC, Singh RP, Chawla YK, et al. Effect of shunt surgery on spleen size, portal pressure and oesophageal varices in patients with non-cirrhotic portal hypertension. J Gastroenterol Hepatol. 1997;12:582–4.

    Article  PubMed  CAS  Google Scholar 

  26. Aster RH. Pooling of platelets in the spleen: role in the pathogenesis of “hypersplenic” thrombocytopenia. J Clin Invest. 1966;45:645–57.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  27. Jandl JH, Aster RH, Forkner CE, Fisher AM, Vilter RW. Splenic pooling and the pathophysiology of hypersplenism. Trans Am Clin Climatol Assoc. 1967;78:9–27.

    PubMed  PubMed Central  CAS  Google Scholar 

  28. Kaplan ME, Jandl JH. The effect of rheumatoid factors and of antigobulins of immune hemolysis in vivo. J Exp Med. 1963;117:105–25.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  29. Schaffner A, Augustiny N, Otto RC, Fehr J. The hypersplenic spleen. A contractile reservoir of granulocytes and platelets. Arch Intern Med. 1985;145:651–4.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery and Liver Transplantation, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India

    Ragini Kilambi, Anand Narayan Singh, Sujoy Pal, Nihar Ranjan Dash & Peush Sahni

  2. Department of HPB Surgery, Institute of Liver and Biliary Sciences, D-1, Acharya Shree Tulsi Marg, Vasant Kunj, New Delhi, 110 070, India

    Ragini Kilambi

  3. Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India

    Kumble Seetharama Madhusudhan

  4. Department of Hematology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India

    Renu Saxena

  5. Department of Gastroenterology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India

    Shalimar

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  1. Ragini Kilambi
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Contributions

RK, ANS, SP: conception and design of this work; RK, KSM, RS, S: acquisition of data; RK, ANS, SP, NRD, PS: analysis and interpretation of data. All authors have contributed to drafting this work or revising it critically for important intellectual content. All authors also approve the manuscript in its current form for publication and agree to be accountable for all aspects of the work and to ensure that questions related to the accuracy or integrity of any part of this work will be appropriately investigated and resolved.

Corresponding author

Correspondence to Ragini Kilambi.

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Conflict of interest

RK, ANS, KSM, SP, RS, S, NRD, and PS declare that they have no conflicts of interest.

Ethics statement

The study was performed in a manner to conform with the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown in Springer.com.

The study was approved by the institutional ethics committee.

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No financial support obtained for the study.

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Additional information

Presented as a poster at the 12th World Congress of the International Hepato-Pancreato-Biliary Association, April 20–23, 2016, Sao Paulo, Brazil.

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Kilambi, R., Singh, A.N., Madhusudhan, K.S. et al. Portal hypertension and hypersplenism in extrahepatic portal venous obstruction: Are they related?. Indian J Gastroenterol 37, 202–208 (2018). https://doi.org/10.1007/s12664-018-0864-7

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  • DOI: https://doi.org/10.1007/s12664-018-0864-7

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