Blood Changes after Splenectomy in Portal Hypertension. The ‘Amna Model’

Abstract

Background: Splenectomy is a frequently performed operation for patients with portal hypertension and hypersplenism in areas endemic for schistosomiasis. Reactive thrombocytosis (RT) has been described following splenectomy. Nevertheless, data are lacking on the long term changes of platelet count and other blood cells and indices after splenectomy in such patients.
Objectives: To determine the hematological changes following splenectomy in portal hypertension due to schistosomiasis.
Methods: This is a prospective, observational, case study in which we did a series of full blood counts before and after splenectomy on two patients. The periods of study were 12 days and 5 months, respectively.
Results: Platelets (RT >500x10⁹) occurred after the 7^th post-splenectomy day in both patients. In the longer study, RT continued from day 8 to week10. Extreme thrombocytosis (> 1000x 10⁹) occurred from day 11 to day 21 postoperatively. The count was back to normal by week 17. Reactive leukocytosis occurred immediately after ligation of the splenic artery, but returned to normal levels during the 2^nd postoperative week. Erythrocytes, however, showed changes different from both platelets and leukocytes. There was ‘persistent anaemia’ for about one month postoperatively.
Conclusion: This study provides data that were lacking on the long term haematological effects of splenectomy in Sudanese patients with portal hypertension. Knowing these changes can have important implications on the management and follow up of such patients, and provide evidence
needed for discussing guidelines of treatment. RT and leukocytosis occur after splenectomy whereas anaemia persists. RT can reach extreme levels and it is wise to monitor the platelets after the discharge of patients from the hospital. It may also be wise to consider the use of antiplatelet drugs postoperatively till the count normalizes. The persistent anaemia, however, seems to correct itself without giving haematinics or blood transfusion.

Key words: postsplenectomy, thrombocytosis, portal hypertension, hypersplenism.