Our Summary

This study looks at the effects of surgical removal of the spleen (splenectomy) on high blood pressure in the portal vein (portal hypertension, PH), a condition often associated with an enlarged spleen (splenomegaly). This enlargement is due to a backup of blood in the vein and excessive blood flow in the abdomen, which can lead to low blood cell counts (cytopenia). The study involved 96 rats, which were divided into groups and underwent different procedures.

In the two groups of rats that had surgeries to mimic the conditions of portal hypertension (either by partially tying off the portal vein or tying off the bile duct), there was a steady increase in portal pressure, along with a drop in average arterial pressure and a faster heart rate. In the rats that also had their spleens removed, however, the increase in portal pressure was less, and the average arterial pressure and heart rate improved.

Additionally, the rats without spleens had lower levels of a protein that indicates blood vessel damage, and they had higher levels of hemoglobin (a protein in red blood cells that carries oxygen). In the group that had the partial portal vein ligation, the low platelet count (thrombocytopenia) was also improved by removing the spleen. However, in the group that had the bile duct ligation, high platelet count (thrombocytosis) was not affected by removing the spleen.

In conclusion, removing the spleen can improve portal hypertension and related issues in both cirrhotic (liver disease) and non-cirrhotic conditions. But improvements in low red blood cell count and platelet count were only significant in non-cirrhotic portal hypertension.

FAQs

  1. What is the impact of splenectomy on portal pressure and blood cell counts in non-cirrhotic and cirrhotic portal hypertension?
  2. How does splenectomy affect the development of portal hypertension in both non-cirrhotic and cirrhotic models?
  3. What changes in blood parameters were observed in the PPVL and BDL models after splenectomy?

Doctor’s Tip

A helpful tip a doctor might tell a patient about splenectomy is to be aware of the potential impact on blood cell counts and to monitor for changes in hemoglobin levels and platelet counts post-surgery. It is important to follow up with your healthcare provider regularly to ensure proper management of any potential complications related to splenectomy, such as anemia or thrombocytopenia.

Suitable For

Patients who are typically recommended splenectomy include those with portal hypertension-associated splenomegaly, hypersplenism, and cytopenia. This study found that splenectomy can improve both cirrhotic and non-cirrhotic portal hypertension, and ameliorate hyperdynamic circulation. It was especially effective in improving anemia and thrombocytopenia in non-cirrhotic portal hypertension. Therefore, patients with these conditions may benefit from splenectomy as a treatment option.

Timeline

  • Before splenectomy: The patient may be experiencing symptoms of portal hypertension-associated splenomegaly, such as hypersplenism and cytopenia. This can lead to decreased mean arterial pressure, accelerated heart rate, and changes in blood cell counts and hemoglobin concentrations.

  • After splenectomy: Following the surgery, there is a time-dependent impact on portal pressure and blood cell counts. In animal models of non-cirrhotic and cirrhotic portal hypertension, splenectomy curbs the development of portal hypertension, increases mean arterial pressure, and reduces heart rate. Splenectomy also results in higher hemoglobin levels and mean corpuscular hemoglobin concentrations, and can alleviate thrombocytopenia in certain cases. Overall, splenectomy improves both cirrhotic and non-cirrhotic portal hypertension and ameliorates the hyperdynamic circulation.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with splenectomy?
  2. How will the spleen removal affect my immune system and overall health?
  3. Will I need to take any medications or make lifestyle changes after the surgery?
  4. How long is the recovery period after splenectomy?
  5. Are there any long-term effects of living without a spleen that I should be aware of?
  6. Will I need any additional follow-up appointments or monitoring after the surgery?
  7. How will splenectomy affect my risk of infections and ability to fight off illness?
  8. Will I need any vaccinations or preventive measures to protect myself after splenectomy?
  9. How will splenectomy impact my blood cell counts and the development of cytopenia?
  10. Are there any alternative treatments or therapies that I should consider before deciding on splenectomy?

Reference

Authors: Schwabl P, Seeland BA, Riedl F, Schubert TL, Königshofer P, Brusilovskaya K, Petrenko O, Hofer B, Schiefer AI, Trauner M, Peck-Radosavljevic M, Reiberger T. Journal: Adv Med Sci. 2022 Mar;67(1):154-162. doi: 10.1016/j.advms.2022.02.005. Epub 2022 Mar 8. PMID: 35272246