Hypersplenism in schistosomatic portal hypertension.

BACKGROUND: For many years, the hematologic changes occurring in hepatosplenic Manson's schistosomiasis have been defined as hypersplenism. Initially, the belief was that removal of the spleen would normalize the hematologic values. However, hematimetric normalization was observed in surgeries for the treatment of portal hypertension in which the spleen was preserved. In view of these findings, it is necessary to verify the clinical and laboratory profile of these patients in order to define the real presence of hypersplenism.
METHODS: This study was conducted on 51 patients with schistosomatic portal hypertension divided into five groups: group 1, non-operated patients under clinical control; group 2, patients submitted to distal splenorenal shunt; group 3, patients with subtotal splenectomy and central splenorenal shunt; group 4, patients with total splenectomy and central splenorenal shunt; and group 5, patients with total splenectomy and portal-variceal disconnection. Clinical signs of hypersplenism were assessed in all patients. Hematologic values of the pre- and postoperative period were compared. Immunoglobulin counts of the patients were verified in the late postoperative period.
RESULTS: In all operated groups, hematimetric values, leukocyte counts, platelet number and prothrombin time were higher during the postoperative period. With respect to the immunoglobulins, the postoperative values of IgM, IgG and IgA were normal.
CONCLUSIONS: Patients with schistosomatic portal hypertension and peripheral cytopenia cannot be classified as having hypersplenism but rather as having pancytopenia due to splenomegaly caused by difficulty on portal blood drainage.