Prospective evaluation of haematological alterations following the transjugular intrahepatic portosystemic stent-shunt (TIPSS).

BACKGROUND

TIPSS is effective in reducing portal hypertension and provides access to the portal system for direct pressure measurements.

OBJECTIVE

To assess the incidence and severity of haemolysis and its course following TIPSS, and also to assess changes in spleen size and any relationship to changes in the platelet and white cell count and haemoglobin concentration.

DESIGN

A prospective study.

MATERIALS AND METHODS

Twenty-three patients undergoing TIPSS with a mean follow-up of 8 months (SE 1.2) were studied. Male-female ratio was 13:10 and the mean age was 53.6 years (SE 1.7). Full blood count, reticulocyte count, serum haptoglobin, urinary haemosiderin, examination of the peripheral blood smear and spleen size (ultrasonography) were measured prior to and 3, 7 and 30 days after TIPSS and 6-monthly thereafter.

RESULTS

Seven patients (30.4%) developed haemolysis, which was clinically significant in three (13%). This settled spontaneously within 2 weeks of TIPSS. Portal pressure gradient was reduced from a mean of 21.9 (SE 1.6) to 9.5 (SE 1) mmHg (P < 0.001) and did not change significantly thereafter. Haemoglobin concentration improved significantly from a mean of 89 (SE 16) to 113 (SE 19) g/l (P < 0.05) after TIPSS. Significant changes in spleen size and platelet count occurred, with a reduction in the former from 16.9 (SE 1.1) to 13.7 cm (SE 2.4) (P < 0.01) and an increase in the latter from 85.9 (SE 8.4) to 135.3 x 10(9)/l (SE 16.8) (P < 0.01). No significant correlations were found between the changes in the portal pressure gradient, spleen size and platelet count. There was no significant change in the white cell count.

CONCLUSION

Transient significant haemolysis occurs in about 13% of patients following TIPSS. TIPSS is useful for reducing splenomegaly and improving thrombocytopenia and haemoglobin. There is no correlation between the changes in portal pressure gradient, spleen size and platelet count.