Dig Dis Sci: Transjugular intrahepatic portosystemic shunt may improve cytopenia associated with hypersplenism in cirrhosis

Portal hypertension (PH) in patients with advanced chronic liver disease (ACLD) can lead to serious complications in patients with cirrhosis, such as ascites or variceal bleeding
.
Splanchnic venous congestion due to PH may also lead to splenomegaly, which has a prevalence of 50% to 100% in cirrhosis, depending on the underlying cause, and is often complicated by hypersplenism-related
cytopenias.
Hypersplenism mainly induces thrombocytopenia; However, anemia and leukopenia can also occur
.
Because platelet count (PLT) is indirectly related
to the severity of PH (i.
e.
, hepatic venous pressure gradient (HVPG).

Therefore, PLT is widely recognized as an important marker for non-invasive assessment of PH
.
Transjugular intrahepatic portosystemic shunt (TIPS) is effective in the treatment of refractory ascites and severe/recurrent variceal bleeding
.
However, the effect of TIPS on cytopenias has not been fully established
.
Therefore, this study aimed to assess the effects
of transjugular intrahepatic portosystemic shunt (TIPS) implantation on platelet count (PLT), haemoglobin (Hb), and white blood cell count (WBC).

This review retrospectively included people with
cirrhosis who received covered TIPS implantation.
Patients with malignant neoplasms or blood diseases are excluded, and then hematological laboratory indicators are regularly recorded at baseline (pre-TIPS) and after TIPS, with statistical analysis
.

The results of the study showed 192 patients (male: 72.
4%, age: 56 years; MELD: 12.
1 ±3.
6) underwent TIPS implantation
.
Fifty-four (28.
7%) patients developed high-grade (≥G2) thrombocytopenia (PLT<100 g/L), 57 (29.
7%) developed ≥ G2 anemia (Hb<10 g/dL), and ≥G2 leukopenia (WBC<2 G/L) in 3 (1.
6%)
, respectively.
≥G2 thrombocytopenia, anemia, and leukopenia resolved 24/55 (43.
6%), 23/57 (40.
4%), and 2/3 (66.
7%)
, respectively.
Similar results were observed in the subgroup of patients without an indication for "bleeding" tips, with improvement in G≥2 thrombocytopenia and G≥2 anemia in 19.
8% and 10.
2% of patients after TIPS
, respectively.

This study demonstrated frequent improvement
in thrombocytopenia, anaemia, and leukopenia after TIPS.
Therefore, moderate to higher grade thrombocytopenia should not be considered a contraindication to TIPS
.

Original source:

Theresa Bucsics.
et al.
Covered Transjugular Intrahepatic Portosystemic Shunt Improves Hypersplenism-Associated Cytopenia in Cirrhosis.
Digestive Diseases and Sciences.
2022.