CORRECTION OF HEMATOLOGICAL INDICATORS IN PATIENTS WITH PORTAL HYPERTENSION

Authors

  • M. I. Tutchenko Bogomolets National Medical University, Kyiv, Ukraine
  • S. L. Chub Bogomolets National Medical University, Kyiv, Ukraine
  • D. V. Rudyk Bogomolets National Medical University, Kyiv, Ukraine
  • P. V. Ivanchov Bogomolets National Medical University, Kyiv, Ukraine

DOI:

https://doi.org/10.11603/1811-2471.2023.v.i3.14087

Keywords:

liver cirrhosis, portal hypertension, hypersplenism, porto-azygos disconnection, splenectomy

Abstract

SUMMARY. The aim – to evaluate surgical tactics to improve the survival prognosis of patients with PH complicated by bleeding from esophageal varices, and to identify hematological changes in the early postoperative period as a compensatory indicator of PH.

Material and Methods. The clinical material of 34 patients with PG was analyzed (average age – 49.09±1.65 years; 16 men, 18 women). The patients were divided into two groups: the first group – 23 patients, the source of bleeding was eliminated by laparoscopic assisted devascularization of the proximal part of the stomach, abdominal part of the esophagus with its subsequent transection in the epicardial area; the second group – 11 patients additionally performed splenectomy.

Results. In the postoperative period, changes in the dynamics of hematological parameters between the studied groups were detected. In the first group, an increase in the level of erythrocytes on the first day after surgery by 15.61 % compared to the initial values, a decrease by 11.25 % on the third day compared to the first day, and a slight increase by 0.72 % on the eleventh day compared to the third around the clock Whereas, accordingly, in the second group, there was an increase of 18.65 % on the first day, a decrease of 1.31 % on the third day, and a slight decrease of 1 % by the eleventh day.

The dynamics of leukocytosis had a wave-like character: on the first day of the postoperative period, the level of leukocytes increased by 63.39 % in the first group and by 80.56 % in the second group compared to the initial indicators, on the third day there was a decrease of 13.34 % in the first and on 6.37 % in the second group compared to the first day, on the eleventh day a significant decrease in leukocytosis was found by 46.67 % and 45.41 %, respectively.

The dynamics of platelet level changes showed a linear upward trend in both groups. In the first group, the increase was not significant: on the first day by 3.1 %, on the third day by 10.11 %, on the eleventh day by 2.49 %. In the second group, a significant increase was recorded: 165.94 % on the first day, 466.15 % on the third day compared to the first day and 177.76 % on the eleventh day compared to the third day, and compared to the initial level by 1374.95 %, i.e. more than 13.5 times. In the period of 9–12 months, 32 patients were examined, one patient died, 2 patients of the first group had recurrences of bleeding without the need for blood transfusions and resuscitation measures.

Conclusions. 1. Portal hypertension leads not only to significant disturbances in hemodynamic indicators, in the form of venous dilatation, but also in hematological ones, which are due to functional disorders of the liver and pronounced hypersplenism. 2. Performing splenectomy in combination with devascularization of the cardiac part of the stomach and the abdominal part of the esophagus and its hardware transection significantly improves hematological indicators and, as a result, reduces the number of complications and mortality.

References

Horhat, A., Bureau, C., Thabut, D., & Rudler, M. (2021). Transjugular intrahepatic portosystemic shunt in patients with cirrhosis: Indications and posttransjugular intrahepatic portosystemic shunt complications in 2020. United European gastroenterology journal, 9(2), 203-208. DOI: 10.1177/2050640620952637. DOI: https://doi.org/10.1177/2050640620952637

Siramolpiwat, S. (2014). Transjugular intrahepatic portosystemic shunts and portal hypertension-related complications. World journal of gastroenterology, 20(45), 16996-17010. DOI: 10.3748/wjg.v20.i45.16996. DOI: https://doi.org/10.3748/wjg.v20.i45.16996

Dissegna, D., Sponza, M., Falleti, E., Fabris, C., Vit, A., Angeli, P., Piano, S., Cussigh, A., Cmet, S., & Toniutto, P. (2019). Morbidity and mortality after transjugular intrahepatic portosystemic shunt placement in patients with cirrhosis. European journal of gastroenterology & hepatology, 31(5), 626-632. DOI: 10.1097/MEG.0000000000001342. DOI: https://doi.org/10.1097/MEG.0000000000001342

Kraglund, F., Jepsen, P., Amanavicius, N., & Aagaard, N.K. (2019). Long-term effects and complications of the transjugular intrahepatic portosystemic shunt: a single-centre experience. Scandinavian journal of gastroenterology, 54(7), 899-904. DOI: 10.1080/00365521.2019.1630675. DOI: https://doi.org/10.1080/00365521.2019.1630675

Jikai, Y., Dong, W., Li, Z., Rui, D., Tao, Y., Bo, H., Yibo, S., Shixiong, L., Qiangshan, B., & Jianguo, L. (2022). Individualized total laparoscopic surgery based on 3D remodeling for portal hypertension: A single surgical team experience. Frontiers in surgery, 9, 905385. DOI: 10.3389/fsurg.2022.905385. DOI: https://doi.org/10.3389/fsurg.2022.905385

Jiang, Guo-Qing, Bai, Dou-Sheng, Chen, Ping, Qian, Jian-Jun, Jin, Sheng-Jie, Yao, Jie, & Wang, Xiao-Dong (2014) Modified laparoscopic splenectomy and azygoportal disconnection combined with cell salvage is feasible and might reduce the need for blood transfusion. World J. Gastroenterol., 20(48), 18420-18426. DOI: 10.3748/wjg.v20.i48.18420. DOI: https://doi.org/10.3748/wjg.v20.i48.18420

Deng, Z.C., Jiang, W.Z., Chen, L., Tang, X.D., & Liu, S.H. (2020). Laparoscopic VS. Open splenectomy and oesophagogastric devascularisation for liver cirrhosis and portal hypertension: A retrospective cohort study. International journal of surgery (London, England), 80, 79–83. DOI: 10.1016/j.ijsu.2020.06.026. DOI: https://doi.org/10.1016/j.ijsu.2020.06.026

Yang, L., Zhang, Z., Zheng, J., Kong, J., Yang, X., & Wang, W. (2020). Long-term outcomes of oesophagogastric devascularization and splenectomy in patients with portal hypertension and liver cirrhosis. ANZ journal of surgery, 90(11), 2269-2273. DOI: 10.1111/ans.15994. DOI: https://doi.org/10.1111/ans.15994

Gandhi, K.D., Taweesedt, P.T., Sharma, M., & Surani, S. (2021). Hepatopulmonary syndrome: An update. World journal of hepatology, 13(11), 1699-1706. DOI: 10.4254/wjh.v13.i11.1699. DOI: https://doi.org/10.4254/wjh.v13.i11.1699

Simonetto, D.A., Liu, M., & Kamath, P.S. (2019). Portal Hypertension and Related Complications: Diagnosis and Management. Mayo Clinic proceedings, 94(4), 714-726. DOI: 10.1016/j.mayocp.2018.12.020. DOI: https://doi.org/10.1016/j.mayocp.2018.12.020

Garcia-Tsao, G., Abraldes, J. G., Berzigotti, A., & Bosch, J. (2017). Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology (Baltimore, Md.), 65(1), 310-335. DOI: 10.1002/hep.28906. DOI: https://doi.org/10.1002/hep.28906

Qamar, A.A., & Grace, N.D. (2009). Abnormal hematological indices in cirrhosis. Canadian journal of gastroenterology = Journal canadien de gastroenterologie, 23(6), 441-445. DOI: 10.1155/2009/591317. DOI: https://doi.org/10.1155/2009/591317

Tan, C.H., Hall, J.A., Hammonds, K., Dodlapati, J., Linz, W.J., & Henderson, S.M. (2020). Relationship between splenomegaly and transfusion requirements in patients with cirrhosis. Proceedings (Baylor University. Medical Center), 34(1), 44-48. DOI: 10.1080/08998280.2020.1811445 DOI: https://doi.org/10.1080/08998280.2020.1811445

Lewis, S.M., Williams, A., & Eisenbarth, S.C. (2019). Structure and function of the immune system in the spleen. Science immunology, 4(33). DOI: 10.1126/sciimmunol.aau6085. DOI: https://doi.org/10.1126/sciimmunol.aau6085

Steiniger, B.S. (2015). Human spleen microanatomy: why mice do not suffice. Immunology, 145(3), 334-346. DOI: 10.1111/imm.12469. DOI: https://doi.org/10.1111/imm.12469

Hitchcock, I.S., & Kaushansky, K. (2014). Thrombopoietin from beginning to end. British journal of haematology, 165(2), 259-268. DOI: 10.1111/bjh.12772. DOI: https://doi.org/10.1111/bjh.12772

Peck-Radosavljevic, M. (2017). Thrombocytopenia in chronic liver disease. Liver international : official journal of the International Association for the Study of the Liver, 37(6), 778-793. DOI: 10.1111/liv.13317.

Risør, L.M., Fenger, M., Olsen, N.V., & Møller, S. (2016). Hepatic erythropoietin response in cirrhosis. A contemporary review. Scandinavian journal of clinical and laboratory investigation, 76(3), 183-189. DOI: 10.3109/ 00365513.2016.1143563. DOI: https://doi.org/10.3109/00365513.2016.1143563

Matsuura, R., Doi, K., Komaru, Y., Miyamoto, Y., Yoshida, T., Isegawa, T., … & Nangaku, M. (2019). Endogenous Erythropoietin and Hepatic Dysfunction in Acute Kidney Injury Requiring Renal Replacement Therapy. Nephron, 142(1), 10-16. DOI: 10.1159/000496618. DOI: https://doi.org/10.1159/000496618

Jakab, S.S., & Garcia-Tsao, G. (2020). Evaluation and Management of Esophageal and Gastric Varices in Patients with Cirrhosis. Clinics in liver disease, 24(3), 335-350. DOI: 10.1016/j.cld.2020.04.011. DOI: https://doi.org/10.1016/j.cld.2020.04.011

O'Leary, J.G., Greenberg, C.S., Patton, H.M., & Caldwell, S.H. (2019). AGA Clinical Practice Update: Coagulation in Cirrhosis. Gastroenterology, 157(1), 34-43.e1. DOI: 10.1053/j.gastro.2019.03.070. DOI: https://doi.org/10.1053/j.gastro.2019.03.070

Islam, R., Kundu, S., Jha, S.B., Rivera, A.P., Flores Monar, G. V., Islam, H., Puttagunta, S.M., & Sange, I. (2022). Cirrhosis and Coagulopathy: Mechanisms of Hemostasis Changes in Liver Failure and Their Management. Cureus, 14(4), e23785. DOI: 10.7759/cureus.23785. DOI: https://doi.org/10.7759/cureus.23785

Peck-Radosavljevic, M. (2017). Thrombocytopenia in chronic liver disease. Liver international : official journal of the International Association for the Study of the Liver, 37(6), 778-793. DOI: 10.1111/liv.13317. DOI: https://doi.org/10.1111/liv.13317

Feng, R., Liu, Y., Zhu, X.L., Zhai, W.Y., He, Y., Fu, H.X., … & Zhang, X.H. (2022). Recombinant human thrombopoietin increases platelet count in severe thrombocytopenic patients with hepatitis B-related cirrhosis: Multicentre real-world observational study. Journal of viral hepatitis, 29(5), 306-316. DOI: 10.1111/jvh.13655. DOI: https://doi.org/10.1111/jvh.13655

Khemichian, S., & Terrault, N.A. (2020). Thrombopoietin Receptor Agonists in Patients with Chronic Liver Disease. Seminars in thrombosis and hemostasis, 46(6), 682-692. DOI: 10.1055/s-0040-1715451. DOI: https://doi.org/10.1055/s-0040-1715451

Gilreath, J., Lo, M., & Bubalo, J. (2021). Thrombopoietin Receptor Agonists (TPO-RAs): Drug Class Considerations for Pharmacists. Drugs, 81(11), 1285-1305. DOI: 10.1007/s40265-021-01553-7. DOI: https://doi.org/10.1007/s40265-021-01553-7

Takahashi, K., Nagai, S., Safwan, M., Liang, C., & Ohkohchi, N. (2018). Thrombocytopenia after liver transplantation: Should we care?. World journal of gastroenterology, 24(13), 1386-1397. DOI: 10.3748/wjg.v24.i13.1386. DOI: https://doi.org/10.3748/wjg.v24.i13.1386

Zhang, L., Zhang, Z.G., Long, X., Liu, F.L., & Zhang, W.G. (2020). Severe Complications After Splenic Artery Embolization for Portal Hypertension Due to Hepatic Cirrhosis. Risk management and healthcare policy, 13, 135-140. DOI: 10.2147/RMHP.S234628. DOI: https://doi.org/10.2147/RMHP.S234628

Ni, Y.B., Gao, P.J., Wang, D., Li, Z., & Zhu, J.Y. (2015). Esophagogastric devascularization without splenectomy in portal hypertension: safe and effective? Hepatobiliary & pancreatic diseases international : HBPD INT, 14(3), 276-280. DOI: 10.1016/s1499-3872(15)60328-9. DOI: https://doi.org/10.1016/S1499-3872(15)60328-9

Lin, J., Liu, Q., Liang, Z., He, W., Chen, J., Ma, J., Gu, C., & Wang, W. (2019). Laparoscopic selective esophagogastric devascularization and splenectomy for patients with cirrhotic portal hypertension. Wideochirurgia i inne techniki maloinwazyjne = Videosurgery and other miniinvasive techniques, 14(2), 187-194. DOI: 10.5114/wiitm.2018.80297. DOI: https://doi.org/10.5114/wiitm.2018.80297

Li, J., Wu, Q.Q., Zhu, R.H., Lv, X., Wang, W.Q., Wang, J.L., Liang, B.Y., Huang, Z.Y., & Zhang, E.L. (2022). Machine learning predicts portal vein thrombosis after splenectomy in patients with portal hypertension: Comparative analysis of three practical models. World journal of gastroenterology, 28(32), 4681-4697. DOI: 10.3748/wjg.v28.i32.4681. DOI: https://doi.org/10.3748/wjg.v28.i32.4681

Wu, L.F., Bai, D.S., Shi, L., Jin, S.J., Zhou, B.H., & Jiang, G.Q. (2022). Predictors of portal vein thrombosis after laparoscopic splenectomy and azygoportal disconnection in hepatitis B cirrhosis: a prospective study. Surgical Endoscopy, 36(6), 4090-4098. DOI: 10.1007/s00464-021-08730-5. DOI: https://doi.org/10.1007/s00464-021-08730-5

Published

2023-08-23

How to Cite

Tutchenko, M. I., Chub, S. L., Rudyk, D. V., & Ivanchov, P. V. (2023). CORRECTION OF HEMATOLOGICAL INDICATORS IN PATIENTS WITH PORTAL HYPERTENSION . Achievements of Clinical and Experimental Medicine, (3), 165–172. https://doi.org/10.11603/1811-2471.2023.v.i3.14087

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