What Does My Portal Hypertension Have to Do With My Blood Counts?

A Review of Hypersplenism in People With Portal Hypertension

Doctor Discussing Treatment Options
Doctor Discussing Treatment Options. Hero Images/Creative RF/Getty Images

If you have portal hypertension and are referred to a hematologist, you might wonder why a blood doctor cares about your liver problem. People with portal hypertension have an increased resistance to blood flow into one of the portal veins (veins that drain blood from the gastrointestinal tract). This increased resistance to blood flow is often without symptoms until complications occur.

These complications include splenomegaly, an enlargement of the spleen.

Splenomegaly generally has no specific symptoms. People with splenomegaly may describe a fullness to the abdomen, particularly on the left side where the spleen is located. They may also complain of feeling full after eating only a small amount of food. This is caused by the enlarged spleen pressing on the stomach.

Splenomegaly can generally be felt on examination by your physician but if needed an ultrasound can confirm the diagnosis. 

The Spleen and Blood Counts

The splenomegaly in portal hypertension can result in low blood counts. One of the spleen's job is to filter all of the blood cells so that aging or damage blood cells can be removed from circulation. So at any point in time a certain number of red blood cells, white blood cells, and platelets are physically located in the spleen.

As the spleen enlarges, more of these cells are trapped in the spleen. Additionally, this can lead to removal of blood cells faster than normal.

This can lead to anemia (low number of red blood cells), thrombocytopenia (low number of platelets), and leukopenia (low number of white blood cells).

These changes are usually found during routine blood work that includes a complete blood count (CBC). In general the amount of anemia, thrombocytopenia, and/or leukopenia seen is mild to moderate with minimal symptoms.

Not all three types of blood cells have to be affected. Additionally, the severity is partially determined by the spleen size. As the spleen size increases, the blood counts can go lower or vice versa, blood counts can increase if the spleen decreases in size. 

Is Treatment Required?

The severity of your anemia/thrombocytopenia/leukopenia determines whether you should be treated or not. Fortunately, many people only have only mild changes in the blood count and do not require treatment.

Treatment of the portal hypertension itself can sometimes improve the blood counts. If the changes are severe, splenectomy (surgical removal of the spleen) may be recommended. Deciding whether you need splenectomy must be weighed carefully with the risks of this treatment, mainly an increased risk of sepsis (severe bacterial infection of the blood).

If you are to undergo splenectomy, it is important for you to immunized against the bacteria that most commonly cause these infections: Streptococcus pneumoniaeNeisseria meningitidis, and Haemophilus influenzae type b (not to be confused with the more common influenza virus). To optimize the response to these immunizations, they should be given at least 14 days prior to the splenectomy.

 If the surgery is urgent and immunizations cannot be given beforehand, they can be administered on day 14 post-operatively.

Afterwards, you will likely be placed on penicillin for a minimum of one year, sometimes indefinitely. All fevers require medical evaluations to rule out bacterial infection. Fortunately, immunizations have reduced the likelihood of these infections. 

A Word From Verywell

Hearing that your portal hypertension and splenomegaly have caused you to have low blood counts may alarm you. Fortunately, most of the time these changes are minimal and do not require treatment. Discussing your concerns with your medical team may help relieve your anxiety about this particular complication.

Sources:

Schrier SL. Approach to the adult patient with splenomegaly and other splenic disorders, Extrinsic nonimmune hemolytic anemia due to mechanical damage: Fragmentation hemolysis and hypersplenism. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA.

McClain KL. Approach to the child with an enlarged spleen. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA.

Continue Reading