A comparative analysis of the hemogram and myelogram of patients with liver cirrhosis and the advantages and disadvantages of splenectomy

Huimin LI; Yizhuo CHEN; Rui ZHAO; Xiao HUANG; Fei HUANG; Huanhuan LI

doi:10.3969/j.issn.1001-5256.2023.09.028

Volume 39 Issue 9

Sep. 2023

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Article Navigation > Journal of Clinical Hepatology > 2023 > 39(9): 2217-2224

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A comparative analysis of the hemogram and myelogram of patients with liver cirrhosis and the advantages and disadvantages of splenectomy

DOI: 10.3969/j.issn.1001-5256.2023.09.028

1.
Department of Obstetrics and Gynecology，The First Clinical Medical College of Xi’an Jiaotong University，Xi’an 710061，China
2.
The Second Clinical Medical College，Lanzhou University，Lanzhou 730000，China
3.
Department of Liver Diseases，Lanzhou University Second Hospital，Lanzhou 730000，China

Research funding:

The Second Hospital of Lanzhou University CUIYING Students Research And Cultivation Program (CYXZ2020－27)

More Information

Corresponding author: ZHAO Rui， ldeyzr@126.com （ORCID： 0000－0002－7986－0518）
Received Date: 2022-11-24
Accepted Date: 2022-12-29
Published Date: 2023-09-19

Abstract

Abstract

Compensated liver cirrhosis （CLC） and decompensated liver cirrhosis （DLC） are the two clinically distinct stages of liver cirrhosis. CLC often has atypical symptoms， while DLC has a variety of clinical manifestations， mainly hypersplenism， i.e.， splenomegaly with abnormal hemogram （reductions in white blood cell count， red blood cell count， and platelet count）. In China， the indications for splenectomy include secondary hypersplenism， space－occupying lesions in the spleen， and traumatic splenic rupture， among which secondary hypersplenism is frequently observed in DLC. However， after splenectomy， some patients have no improvement and experience a series of complications. It has long been assumed that hemogram changes in DLC patients are mainly associated with hypersplenism， while myelogram changes are not taken seriously and are often neglected. Identifying the cause of hemogram changes in such patients is the key to the selection of treatment methods. Therefore， by summarizing the association between the hemogram and myelogram of patients with DLC， this article points out the drawbacks of performing splenectomy at random， so as to provide correct knowledge and guidance for the treatment of patients with DLC and hypersplenism.
- Liver Cirrhosis,
- Hypersplenism,
- Splenectomy

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References(43)

References

[1]	Chinese Society of Hepatology, Chinese Medical Association. Chinese guidelines on the management of liver cirrhosis[J]. J Clin Hepatol, 2019, 35( 11): 2408－ 2425. DOI: 10.3969/j.issn.1001－5256.2019.11.006. 中华医学会肝病学分会. 肝硬化诊治指南[J]. 临床肝胆病杂志, 2019, 35( 11): 2408－ 2425. DOI: 10.3969/j.issn.1001－5256.2019.11.006.
[2]	BUZELÉ R, BARBIER L, SAUVANET A, et al. Medical complications following splenectomy[J]. J Visc Surg, 2016, 153( 4): 277－ 286. DOI: 10.1016/j.jviscsurg.2016.04.013.
[3]	SUN W, GAO B, XUE DP, et al. Progress in mechanism and treatment of cirrhosis complicated with cytopenia[J]. Hepatopancreatobiliary Surg, 2014, 26( 1): 83－ 85, 88. DOI: 10.13709/j.cnki.1007－1954.2014.01.029. 孙旺, 高博, 薛东波, 等. 肝硬化并发血细胞减少的机制和治疗进展[J]. 肝胆胰外科杂志, 2014, 26( 1): 83－ 85, 88. DOI: 10.13709/j.cnki.1007－1954.2014.01.029.
[4]	WANG YX, LIANG P, DONG BW. Progress in pathogenesis and treatment of cirrhosis of liver with hypersplenism[J]. J Chin Phys, 2003( z1): 306－ 308. DOI: 10.3760/cma.j.issn. 1008－1372.2003.z1.241. 王月香, 梁萍, 董宝玮. 肝硬化脾功能亢进的发病机制与治疗进展[J]. 中国医师杂志, 2003( z1): 306－ 308. DOI: 10.3760/cma.j.issn.1008－1372.2003.z1.241.
[5]	KIM HY, CHO EJ, CHUN S, et al. Red blood cell alloimmunization in Korean patients with myelodysplastic syndrome and liver cirrhosis[J]. Ann Lab Med, 2019, 39( 2): 218－ 222. DOI: 10.3343/alm.2019.39.2.218.
[6]	WU X, YAO Z, ZHAO L, et al. Phosphatidylserine on blood cells and endothelial cells contributes to the hypercoagulable state in cirrhosis[J]. Liver Int, 2016, 36( 12): 1800－ 1810. DOI: 10.1111/liv.13167.
[7]	RIOS R, SANGRO B, HERRERO I, et al. The role of thrombopoietin in the thrombocytopenia of patients with liver cirrhosis[J]. Am J Gastroenterol, 2005, 100( 6): 1311－ 1316. DOI: 10.1111/j.1572－0241.2005.41543.x.
[8]	MARTIN TG 3rd, SOMBERG KA, MENG YG, et al. Thrombopoietin levels in patients with cirrhosis before and after orthotopic liver transplantation[J]. Ann Intern Med, 1997, 127( 4): 285－ 288. DOI: 10.7326/0003－4819－127－4－199708150－00005.
[9]	SCHMIDT KG, RASMUSSEN JW, BEKKER C, et al. Kinetics and in vivo distribution of 111－In－labelled autologous platelets in chronic hepatic disease: mechanisms of thrombocytopenia[J]. Scand J Haematol, 1985, 34( 1): 39－ 46. DOI: 10.1111/j.1600－0609.1985.tb00742.x.
[10]	REN S, ZHANG S, LI M, et al. NF－κB p65 and c－Rel subunits promote phagocytosis and cytokine secretion by splenic macrophages in cirrhotic patients with hypersplenism[J]. Int J Biochem Cell Biol, 2013, 45( 2): 335－ 343. DOI: 10.1016/j.biocel.2012.11.012.
[11]	LYU YF. Pathogeny and treatment of cirrhotic portal hypertension complicated by peripheral blood cytope－nia[J]. J Clin Surg, 2018, 26( 5): 396－ 398. DOI: 10.3969/j.issn. 1005－6483.2018.05.026. 吕云福. 肝硬化门静脉高压症并发外周血细胞减少的病因与治疗[J]. 临床外科杂志, 2018, 26( 5): 396－ 398. DOI: 10.3969/j.issn.1005－6483.2018.05.026.
[12]	PECK－RADOSAVLJEVIC M. Thrombocytopenia in chronic liver disease[J]. Liver Int, 2017, 37( 6): 778－ 793. DOI: 10.1111/liv.13317.
[13]	CHAFFANJON PC, BRICHON PY, RANCHOUP Y, et al. Portal vein thrombosis following splenectomy for hematologic disease: prospective study with Doppler color flow imaging[J]. World J Surg, 1998, 22( 10): 1082－ 1086. DOI: 10.1007/s002689900521.
[14]	KALAMBOKIS G, TSIANOS EV. Endotoxaemia in the pathogenesis of cytopenias in liver cirrhosis. Could oral antibiotics raise blood counts?[J]. Med Hypotheses, 2011, 76( 1): 105－ 109. DOI: 10.1016/j.mehy.2010.08.043.
[15]	MIRSHEKAR－SYAHKAL B, FITCH SR, OTTERSBACH K. Concise review: From greenhouse to garden: the changing soil of the hematopoietic stem cell microenvironment during development[J]. Stem Cells, 2014, 32( 7): 1691－ 1700. DOI: 10.1002/stem.1680.
[16]	BIHARI C, ANAND L, ROOGE S, et al. Bone marrow stem cells and their niche components are adversely affected in advanced cirrhosis of the liver[J]. Hepatology, 2016, 64( 4): 1273－ 1288. DOI: 10.1002/hep.28754.
[17]	CHEN XH, ZHENG XY, PENG CX. Analysis of clinical etiology, peripheral blood and bone marrow features in patients with decompensated cirrhosis and hematological abnormality[J]. Chin J Health Lab Technol, 2019, 29( 12): 1522－ 1524. 陈秀花, 郑晓燕, 彭春仙. 肝硬化失代偿期血液异常的临床病因与外周血常规、骨髓细胞学特征分析[J]. 中国卫生检验杂志, 2019, 29( 12): 1522－ 1524.
[18]	MENDELSON A, FRENETTE PS. Hematopoietic stem cell niche maintenance during homeostasis and regeneration[J]. Nat Med, 2014, 20( 8): 833－ 846. DOI: 10.1038/nm.3647.
[19]	YANG YY, LIN HC, LEE WC, et al. Plasma erythropoietin level in patients with cirrhosis and its relationship to the severity of cirrhosis and renal function[J]. J Gastroenterol Hepatol, 2003, 18( 10): 1156－ 1161. DOI: 10.1046/j.1440－1746.2003.03144.x.
[20]	KUBOTA A, OKAMURA S, OMORI F, et al. High serum levels of granulocyte－macrophage colony－stimulating factor in patients with liver cirrhosis and granulocytopenia[J]. Clin Lab Haematol, 1995, 17( 1): 61－ 63. DOI: 10.1111/j.1365－2257.1995.tb00319.x.
[21]	WAI CT. Correcting thrombocytopenia in patients with liver diseases: a difficult hurdle[J]. J Gastroenterol Hepatol, 2013, 28( 2): 207－ 208. DOI: 10.1111/jgh.12052.
[22]	CHU H, HAN W, WANG L, et al. Long－term efficacy of subtotal splenectomy due to portal hypertension in cirrhotic patients[J]. BMC Surg, 2015, 15: 89. DOI: 10.1186/s12893－015－0077－2.
[23]	INAGAKI Y, SUGIMOTO K, SHIRAKI K, et al. The long－term effects of splenectomy and subsequent interferon therapy in patients with HCV－related liver cirrhosis[J]. Mol Med Rep, 2014, 9( 2): 487－ 492. DOI: 10.3892/mmr.2013.1856.
[24]	NIELSEN JS, MCNAGNY KM. CD34 is a key regulator of hematopoietic stem cell trafficking to bone marrow and mast cell progenitor trafficking in the periphery[J]. Microcirculation, 2009, 16( 6): 487－ 496. DOI: 10.1080/10739680902941737.
[25]	DENG ZC, JIANG WZ, CHEN L, et al. Laparoscopic VS. Open splenectomy and oesophagogastric devascularisation for liver cirrhosis and portal hypertension: A retrospective cohort study[J]. Int J Surg, 2020, 80: 79－ 83. DOI: 10.1016/j.ijsu.2020.06.026.
[26]	CHENG Z, LI JW, CHEN J, et al. Therapeutic effects of laparoscopic splenectomy and esophagogastric devascularization on liver cirrhosis and portal hypertension in 204 cases[J]. J Laparoendosc Adv Surg Tech A, 2014, 24( 9): 612－ 616. DOI: 10.1089/lap.2014.0036.
[27]	BAI DS, QIAN JJ, CHEN P, et al. Laparoscopic azygoportal disconnection with and without splenectomy for portal hypertension[J]. Int J Surg, 2016, 34: 116－ 121. DOI: 10.1016/j.ijsu.2016.08.519.
[28]	CHAURASIA RK, PRADHAN B, CHAUDHARY S, et al. Child－Turcotte－Pugh versus model for end stage liver disease score for predicting survival in hospitalized patients with decompensated cirrhosis[J]. J Nepal Health Res Counc, 2013, 11( 23): 9－ 16.
[29]	WOLLERT KC, MEYER GP, MÜLLER－EHMSEN J, et al. Intracoronary autologous bone marrow cell transfer after myocardial infarction: the BOOST－2 randomised placebo－controlled clinical trial[J]. Eur Heart J, 2017, 38( 39): 2936－ 2943. DOI: 10.1093/eurheartj/ehx188.
[30]	ASANOMA M, IKEMOTO T, MORI H, et al. Cytokine expression in spleen affects progression of liver cirrhosis through liver－spleen cross－talk[J]. Hepatol Res, 2014, 44( 12): 1217－ 1223. DOI: 10.1111/hepr.12267.
[31]	YAMADA S, MORINE Y, IMURA S, et al. Liver regeneration after splenectomy in patients with liver cirrhosis[J]. Hepatol Res, 2016, 46( 5): 443－ 449. DOI: 10.1111/hepr.12573.
[32]	NAM NH, TAURA K, YAO S, et al. Pretransplantation splenomegaly frequently persists after liver transplantation and can manifest as hypersplenism and graft fibrosis－a retrospective study[J]. Transpl Int, 2020, 33( 12): 1807－ 1820. DOI: 10.1111/tri.13761.
[33]	LI J, LI R, JIANG W, et al. Splenic serum from portal hypertensive patients enhances liver stem cell proliferation and self－renewal via the IGF－II/ERK signaling pathway[J]. Dig Liver Dis, 2020, 52( 2): 205－ 213. DOI: 10.1016/j.dld.2019.07.014.
[34]	WANG H, SHEN XX, CHEN LQ, et al. Association of JAK/STAT signaling pathway with portal vein thrombosis in cirrhotic patients with portal hypertension after splenectomy[J]. J Clin Hepatol, 2022, 38( 10): 2260－ 2264. DOI: 10.3969/j.issn.1001－5256.2022.10.012. 王欢, 申晓旭, 陈良琪, 等. 肝硬化门静脉高压症患者脾切除后早期血栓形成与Janus激酶－信号转导和转录激活因子信号通路的关系[J]. 临床肝胆病杂志, 2022, 38( 10): 2260－ 2264. DOI: 10.3969/j.issn.1001－5256.2022.10.012.
[35]	CHEN P, WANG SL. Analysis of multiple risk factors affecting postoperative complications in splenectomy[J]. J Hepatobil Surg, 2010, 18( 6): 456－ 458. DOI: 10.3969/j.issn.1006－4761.2010.06.021. 陈平, 王胜利. 脾切除术后并发症发生相关危险因素分析[J]. 肝胆外科杂志, 2010, 18( 6): 456－ 458. DOI: 10.3969/j.issn.1006－4761.2010.06.021.
[36]	ZHU L, ZHAO G, LI Y. Clinical analysis on three cases of posthepatitic cirrhosis associated with hematopathy[J]. Chin J Gastroenterol Hepatol, 2010, 19( 8): 754, 757. DOI: 10.3969/j.issn.1006－5709.2010.08.021. 朱磊, 赵钢, 李岩. 肝炎后肝硬化合并血液病3例报告及临床分析[J]. 胃肠病学和肝病学杂志, 2010, 19( 8): 754, 757. DOI: 10.3969/j.issn.1006－5709.2010.08.021.
[37]	ZHU LT, JIANG HC, LIU LX, et al. Research progress of the precautions of postsplenctomy infective complications[J/CD]. Chin Arch Gen Surg(Electronic Edition), 2019, 13( 3): 244－ 248. DOI: 10.3877/cma.j.issn.1674－0793.2019.03.017. 朱龙图, 姜洪池, 刘连新, 等. 预防脾切除术后感染性并发症的研究进展[J]. 中华普通外科学文献(电子版), 2019, 13( 3): 244－ 248. DOI: 10.3877/cma.j.issn.1674－0793.2019.03.017.
[38]	JI R, NI Y, WANG CY, et al. The causes and management after splenectomy persistent fever in patients with portal hypertension[J]. Lingnan Mod Clin Surg, 2009, 9( 6): 422－ 424. DOI: 10.3969/j.issn.1009－976X.2009.06.010. 纪任, 倪勇, 王成友, 等. 门静脉高压症脾切除术后持续性发热原因的探讨及处理[J]. 岭南现代临床外科, 2009, 9( 6): 422－ 424. DOI: 10.3969/j.issn.1009－976X.2009.06.010.
[39]	YANG ZM, ZHANG LY. Risk factors for portal vein thrombosis following splenectomy in patients with liver cirrhosis[J]. J Clin Hepatol, 2015, 31( 7): 1173－ 1175. DOI: 10.3969/j.issn.1001－5256.2015.07.044. 杨正茂, 张岭漪. 肝硬化患者脾切除术后门静脉血栓形成的危险因素[J]. 临床肝胆病杂志, 2015, 31( 7): 1173－ 1175. DOI: 10.3969/j.issn.1001－5256.2015.07.044.
[40]	YE QF, SHE XG, MING YZ, et al. Effect of splenectomy in prognosis of human liver transplantation[J]. Chin J Bas Clin General Surg, 2008, 15( 3): 159－ 161. 叶启发, 佘兴国, 明英姿, 等. 脾切除对肝移植预后影响的回顾性探讨[J]. 中国普外基础与临床杂志, 2008, 15( 3): 159－ 161.
[41]	WU Y, LI H, ZHANG T, et al. Splanchnic vein thrombosis in liver cirrhosis after splenectomy or splenic artery embolization: A systematic review and meta－analysis[J]. Adv Ther, 2021, 38( 4): 1904－ 1930. DOI: 10.1007/s12325－021－01652－7.
[42]	YANG C, LIU J, SHI Q, et.al. Effect of splenectomy on the outcomes in patients with cirrhosis receiving transjugular intrahepatic portosystemic shunt[J]. J Gastroenterol Hepatol, 2021, 36( 10): 2893－ 2902. DOI: 10.1111/jgh.15543.
[43]	JIANG HC. Review of splenic surgery from the perspective of 100 years[J]. Chin J Dig Surg, 2015, 14( 1): 13－ 14. DOI: 10.3760/j.issn.1673－9752.2015.01.027. 姜洪池. 从百年回眸视角看脾脏外科进展[J]. 中华消化外科杂志, 2015, 14( 1): 13－ 14. DOI: 10.3760/j.issn.1673－9752.2015.01.027.

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A comparative analysis of the hemogram and myelogram of patients with liver cirrhosis and the advantages and disadvantages of splenectomy

DOI: 10.3969/j.issn.1001-5256.2023.09.028

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A comparative analysis of the hemogram and myelogram of patients with liver cirrhosis and the advantages and disadvantages of splenectomy

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