THE HEMATOLOGIC CONSEQUENCES OF TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNTS

Transjugular intrahepatic portosystemic shunts (TIPS) are a recent inn ovation in the management of portal hypertension. In 1992, we had prev iously described an instance of severe hemolysis associated with this procedure. This study was undertaken to define and quantify the true i ncidence of TIPS-associated hemolysis and its clinical spectrum, as we ll as to test the hypothesis that portal decompression by TIPS would a meliorate hypersplenism in patients with portal hypertension. A total of 60 patients undergoing TIPS for prevention of recurrent variceal he morrhage (n = 40) or refractory ascites (n = 20) were studied. Forty p atients with cirrhosis who were followed concurrently served as contro ls. At entry, both groups were comparable with the exception of increa sed ascites in the TIPS group. A total of 7 instances of intravascular hemolysis were identified in 60 TIPS patients, whereas none occurred in controls. Of these, 4 patients were asymptomatic and detected on ro utine laboratory testing. Hemolysis led to a greater than 4-g/dL decre ase in hemoglobin in 2 patients, 2- to 3-g/dL decrease in 2 others and a 3- to 4-gm/dL decrease in 1 patient. Two patients were able to comp ensate for hemolysis and did not develop anemia. In all but 1 case, th e findings of hemolysis subsided by 12 to 15 weeks; in 1 patient, orth otopic liver transplantation was associated with resolution of the hem olysis. Overall, no significant changes in white blood cell or platele t counts mere observed in patients undergoing TIPS despite adequate po rtal decompression. We conclude that TIPS-induced hemolysis occurs in approximately 10% of subjects. However, it is self-limited and rarely requires intervention. Potential mechanisms of such hemolysis are disc ussed. TIPS is also not recommended as a means of improving platelet c ounts in patients with severe hypersplenism.