Trombositopenisi Olan Karaciğer Sirozu Hastalarında Dalak Boyutunun Lökosit ve Trombosit Düzeyleri Üzerindeki Etkisinin Değerlendirilmesi: Retrospektif Tek Merkezli Bir Çalışma

Abstract

Giriş: Karaciğer sirozu hastalarında sitopeniler klinik bir problem olarak hasta takiplerinde ortaya çıkabilmektedir. Biz bu çalışmada trombosit sayısı 100 bin/mikrolitre’nin altında olan karaciğer sirozu hastalarında, dalak boyutları ile trombosit/WBC/nötrofil/lenfosit/monosit düzeyleri arasında bir ilişki olup olmadığını değerlendirmeyi amaçladık. Materyal ve Metod: Hastalar, dalak boyutlarına göre 4 gruba ayrıldı. Dalak boyutu normal olarak bildirilmiş olan hastalar (Dalak uzunluğu ≤ 13 cm(santimetre) olan hastalar da bu gruba dahil edildi) birinci grup , dalak uzunluğu 13 cm-15 cm arasında olanlar ( 13 cm dahil değil, 15 cm dahil değil) ikinci grup , dalak uzunluğu 15 cm – 18 cm arasında olanlar (15 cm dahil, 18 cm dahil değil) üçüncü grup, dalak uzunluğu ≥18 cm olanlar dördüncü grup olarak sınıflandırıldı. Gruplar arasında WBC, nötrofil, lenfosit, monosit düzeylerine göre farklılık olup olmadığı araştırıldı. Bulgular: Dalak uzunluğu ≥18 cm olanlarda dalak uzunluğu < 15 cm olanlara göre trombosit düzeyinin istatistiksel olarak anlamlı düzeyde daha düşük olduğu görüldü (p<0,05). Dalak uzunluğu ≥ 15 cm olanlarda dalak uzunluğu < 15 cm olanlara göre WBC, lenfosit ve monosit düzeylerinin istatistiksel olarak anlamlı düzeyde daha düşük olduğu bulundu (p<0,05). Tartışma: Dalak uzunluğu <15 cm olan karaciğer sirozu hastalarında lökopeni/trombositopeni hemen siroza bağlanmamalıdır ve o durumlarda sitopeniye yol açabilecek diğer potansiyel sebepler de akılda tutulmalıdır.

Keywords

• Karaciğer Sirozu
• splenomegali
• lenfopeni
• nötropeni
• trombositopeni

Evaluation of the Effect of Spleen Size on Leukocyte and Platelet Levels in Liver Cirrhosis Patients With Thrombocytopenia: A Retrospective Single-Center Study.

Abstract

Introduction: In patients with liver cirrhosis, cytopenias may occur as a clinical problem during patient follow-up. In this study, we aimed to evaluate whether there is a relationship between spleen size and platelet/WBC/neutrophil/lymphocyte/monocyte levels in liver cirrhosis patients who had platelet counts below 100 thousand/microliter. Matherial&Methods: The patients were classified into 4 groups according to their spleen size. Patients whose spleen size was reported to be normal (patients with spleen length ≤ 13 cm (centimeters) were also included in this group) were classified as group 1, patients with a spleen length between 13-15 cm (13 cm not included, 15 cm not included) were classified as group 2, those with a spleen length between 15 cm - 18 cm (15 cm included, 18 cm not included) were classified as group 3, and those with a spleen length ≥18 cm were classified as group 4. It was investigated whether there were differences between the groups in terms of WBC, neutrophil, lymphocyte and monocyte levels. Results: It was observed that platelet level was statistically significantly lower in patients with spleen length ≥18 cm compared to those with spleen length <15 cm (p<0,05). It was found that WBC, lymphocyte and monocyte levels were statistically significantly lower in patients with spleen length ≥ 15 cm compared to those with spleen length < 15 cm (p<0,05). Discussion: Leukopenia/thrombocytopenia should not be immediately attributed to cirrhosis in liver cirrhosis patients with spleen length < 15 cm, and other potential cytopenia causes should also be kept in mind in those situations.

Keywords

• Liver Cirrhosis
• splenomegaly
• lymphopenia
• neutropenia
• thrombocytopenia

References

1. 1. Lv, Y., Yee Lau, W., Wu, H., Han, X., Gong, X., Liu, N., Yue, J., Li, Q., Li, Y., Deng, J. 2017. Causes of peripheral cytopenia in hepatitic cirrhosis and portal hypertensive splenomegaly. Experimental Biology and Medicine (Maywood, N.J.), 242(7), 744–749.
2. 2. Lu, Y. F., Li, X. Q., Han, X. Y., Gong, X. G., Chang, S. W. 2013. Peripheral blood cell variations in cirrhotic portal hypertension patients with hypersplenism. Asian Pacific Journal of Tropical Medicine, 6(8), 663–666.
3. 3. Cheson, B. D., Fisher, R. I., Barrington, S. F., Cavalli, F., Schwartz, L. H., Zucca, E., Lister, T. A., Alliance, Australasian Leukaemia and Lymphoma Group, Eastern Cooperative Oncology Group, European Mantle Cell Lymphoma Consortium, Italian Lymphoma Foundation, European Organisation for Research, Treatment of Cancer/Dutch Hemato-Oncology Group, Grupo Español de Médula Ósea, German High-Grade Lymphoma Study Group, German Hodgkin's Study Group, Japanese Lymphorra Study Group, Lymphoma Study Association, NCIC Clinical Trials Group, Nordic Lymphoma Study Group, … United Kingdom National Cancer Research Institute. 2014. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, 32(27), 3059–3068.
4. 4. Aster, R. H. 1966. Pooling of platelets in the spleen: role in the pathogenesis of "hypersplenic" thrombocytopenia. The Journal of Clinical Investigation, 45(5), 645–657.
5. 5. de Sauvage, F. J., Hass, P. E., Spencer, S. D., Malloy, B. E., Gurney, A. L., Spencer, S. A., Darbonne, W. C., Henzel, W. J., Wong, S. C., Kuang, W. J., Oles, K. J., Hultgren, B., Solberg Jr, L. A., Goeddel, D. V., Eaton, D. L. 1994. Stimulation of megakaryocytopoiesis and thrombopoiesis by the c-Mpl ligand. Nature, 369(6481), 533-538.
6. 6. Sungaran, R., Markovic, B., Chong, B. H. 1997. Localization and regulation of thrombopoietin mRNa expression in human kidney, liver, bone marrow, and spleen using in situ hybridization. Blood, 89(1), 101-107.
7. 7. Nomura, S., Ogami, K., Kawamura, K., Tsukamoto, I., Kudo, Y., Kanakura, Y., Kitamura, Y., Miyazaki, H., Kato, T. 1997. Cellular localization of thrombopoietin mRNA in the liver by in situ hybridization. Experimental Hematology, 25(7), 565–572.
8. 8. Martin, T. G., 3rd, Somberg, K. A., Meng, Y. G., Cohen, R. L., Heid, C. A., de Sauvage, F. J., Shuman, M. A. 1997. Thrombopoietin levels in patients with cirrhosis before and after orthotopic liver transplantation. Annals of Internal Medicine, 127(4), 285–288.

9. 9. Gschwantler, M., Vavrik, J., Gebauer, A., Kriwanek, S., Schrutka-Kölbl, C., Fleischer, J., Madani, B., Brownstone, E., Tscholakoff, D., Weiss, W. 1999. Course of platelet counts in cirrhotic patients after implantation of a transjugular intrahepatic portosystemic shunt--a prospective, controlled study. Journal of Hepatology, 30(2), 254–259.
10. 10. Barney, E. J., Little, E. C., Gerkin, R. D., Ramos, A. X., Kahn, J., Wong, M., Kolli, G., Manch, R. 2012. Coated transjugular intrahepatic portosystemic shunt does not improve thrombocytopenia in patients with liver cirrhosis. Digestive Diseases and Sciences, 57(9), 2430–2437.
11. 11. Lv, Y. F., Li, X. Q., Gong, X. G., Xie, X. H., Han, X. Y., Wang, B. C. 2013. Effect of surgery treatment on hypersplenism caused by cirrhotic portal hypertension. Minerva Chirurgica, 68(4), 409–413.
12. 12. Shah, S. H., Hayes, P. C., Allan, P. L., Nicoll, J., Finlayson, N. D. 1996. Measurement of spleen size and its relation to hypersplenism and portal hemodynamics in portal hypertension due to hepatic cirrhosis. The American Journal of Gastroenterology, 91(12), 2580–2583.
13. 13. Latorre, R., Vaquero, J., Rincón, D., Puerto, M., Ponce, M. D., Sarnago, F., Matamoros, J. A., Ramón, E., Elizaga, J., Bañares, R., Ripoll, C. 2016. Determinants of platelet count are different in patients with compensated and decompensated cirrhosis. Liver international: official journal of the International Association for the Study of the Liver, 36(2), 232–239.
14. 14. Mihaylova-Strashilova, M., Tonchev, P. T. 2024. Thrombocytopenia in newly diagnosed cases of liver cirrhosis. Journal of Biomedical and Clinical Research, 17(2), 219-227.