title: Splenectomy for thrombocytopenia in patients with hepatitis C cirrhosis.
abstract: BACKGROUND
  Many patients with hepatitis C cirrhosis and low Model for End-Stage Liver Disease scores are too early for transplant but too thrombocytopenic to treat with interferon.
  
  
  OBJECTIVE
  To report a case series of splenectomy to raise platelet counts so that pegylated interferon and ribavirin can be given in patients with hepatitis C cirrhosis.
  
  
  METHODS
  Retrospective chart and computer record review.
  
  
  RESULTS
  Seven patients with hepatitis C cirrhosis (mean age=45.4+/-11.1 y, 4 men) had elective splenectomy for thrombocytopenia before pegylated interferon-alpha 2b therapy. All had thrombocytopenia contraindicating antiviral therapy. Five were Child's-Pugh Class A; 2 were B. All 7 had increases in platelet count (mean 32,400 to 222,140 /mL, P<0.01) at 221+/-151 days postsurgery. Median hospital stay and blood loss were 9 days (4 to 25) and 750 mL (100 to 2500 mL). Median platelet packs, units of packed red blood cells and fresh frozen plasma given were 1 (0 to 7), 0 (0 to 14) and 0 (0 to 2), respectively. There were no deaths or portal vein thrombosis. One patient who was status-post liver transplantation had significant morbidity. Five completed pegylated interferon-alpha 2b and ribavirin therapy; 1 is on therapy and 1 awaits initiation. Of the 5 who completed therapy, there were 2 with sustained virologic response, 1 nonresponse, 1 breakthrough, and 1 relapse.
  
  
  CONCLUSIONS
  Splenectomy in patients with hepatitis C cirrhosis can be done safely to allow application of antiviral treatment and potentially avoid transplantation. It may be considered in patients with Child's-Pugh A cirrhosis, no prior abdominal surgeries and with non-1 HCV viral genotype.
authors.affiliation: Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, 3635 Vista Avenue, FDT 9th Floor, St Louis, MO 63110-0250, USA. paul_hayashi@med.unc.edu
authors.forename: Paul H
authors.initials: PH
authors.lastname: Hayashi
authors.forename: Carlos
authors.initials: C
authors.lastname: Mehia
authors.forename: H
authors.initials: H
authors.lastname: Joachim Reimers
authors.forename: Harvey S
authors.initials: HS
authors.lastname: Solomon
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Bacon
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols; D011994:Recombinant Proteins; D013156:Splenectomy; D013921:Thrombocytopenia / Q000601:surgery*
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; C417083:peginterferon alfa-2b