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Summarized international guidelines and protocols for Indian patients.
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Hypersplenism
Introduction:
- It is occurrence of one or more cytopenias in the setting of splenomegaly.
Etiology:
- All the causes of splenomegaly can lead to hypersplenism
- Refer to causes of splenomegaly in the approach to diagnosis section
Pathogenesis:
Increased size of filtering bed due to splenomegaly
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Increased proportion of blood is channeled through the red pulp
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Increased margination of neutrophil pool
Increased sequestration of platelets
Increased clearance of RBCs
Cytopenias can also be due to diseases that cause splenomegaly
Clinical Features:
- Sagging feeling/ abdominal discomfort
- Early satiety due to gastric encroachment
- Trouble in sleeping on one side
- Splenomegaly
Investigations:
- Hemogram- Anemia, neutropenia, thrombocytopenia
- USG- Splenomegaly
Criteria for Diagnosis:
- Tropical splenomegaly: Splenomegaly of more than 10cm below costal margin with no other cause identified.
- Sometimes it responds to treatment with antimalarials (Chloroquine), which have to be given for months.
Treatment:
- Depends on the cause
- Splenectomy is useful in some cases, but generally avoided.
- Splenic irradiation
- TPO agonists may be helpful
- Eltrombopag is associated with high risk of portal vein thrombosis. Hence it must be used with caution.
- Avatrombopag is approved for use in chronic liver disease
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