PROSPECTIVE EVALUATION OF HEMATOLOGICAL ALTERATIONS FOLLOWING THE TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC STENT-SHUNT (TIPSS)

Background: TIPSS is effective in reducing portal hypertension and pro vides access to the portal system for direct pressure measurements. Ob jective: To assess the incidence and severity of haemolysis and its co urse following TIPSS, and also to assess changes in spleen size and an y relationship to changes in the platelet and white cell count and hae moglobin concentration. Design: A prospective study. Materials and met hods: Twenty-three patients undergoing TIPSS with a mean followup of 8 months (SE 1.2) were studied. Male-female ratio was 13:10 and the mea n age was 53.6 years (SE 1.7). Full blood count, reticulocyte count, s erum haptoglobin, urinary haemosiderin, examination of the peripheral blood smear and spleen size (ultrasonography) were measured prior to a nd 3, 7 and 30 days after TIPSS and 6-monthly thereafter. Results: Sev en patients (30.4%) developed haemolysis, which was clinically signifi cant in three (13%). This settled spontaneously within 2 weeks of TIPS S. Portal pressure gradient was reduced from a mean of 21.9 (SE 1.6) t o 9.5 (SE 1) mmHg (P < 0.001) and did not change significantly thereaf ter. Haemoglobin concentration improved significantly from a mean of 8 9 (SE 16) to 113 (SE 19) g/l (P < 0.05) after TIPSS. Significant chang es 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 incre ase 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 wa s no significant change in the white cell count. Conclusion: Transient significant haemolysis occurs in about 13% of patients following TIPS S. TIPSS is useful for reducing splenomegaly and improving thrombocyto penia and haemoglobin. There is no correlation between the changes in portal pressure gradient, spleen size and platelet count.