BİROL ÖZER, Ender SERİN, Levent OĞUZKURT, Arif COŞAR, Uğur YILMAZ

HCV'ye sekonder sirozda şiddetli trombositopeni tedavisinde parsiyel splenik embolizasyon

Thrombositopeni hepatit C virüsüne sekonder karaciğer sirozlu hastalarda karşılaşılabilen bir durumdur. Bu hastalardaki trombositopeniden sorumlu mekanizmalar olarak hipersplenizm ve dolaşımda artmış platelet otoantikorları gösterilmektedir. Hepatit C virüsüne sekonder siroz ve dökümante edilmiş portal hipertansiyon ve hipersplenizmi olduğu bilinen 55 yaşında erkek hasta şiddetli trombositopeni (900/microL) ve diş eti kanaması nedeniyle başvurdu. Kortikosteroid tedavisine cevap vermeyen hastaya radyolojik olarak polyvinyl alkol partikülleri ile parsiyel splenik embolizasyon yapıldı. Embolizasyonu takiben dalak volumu %45 azaltıldı. İşlemi takip eden 10 gün içinde platelet sayısı progressif olarak 4,450 den 89,700/ microL'ye kadar yükseldi. Postembolizasyon sendromu olarak hayati tehlike yaratmayan bazı yan etkiler görüldü. Sonuç olarak parsiyel splenik embolizasyon sirotik hastalardaki hipersplenizm tedavisinde güvenli ve etkili bir tedavi yöntemidir.

Partial splenic embolization for the treatment of severe thrombocytopenia in HCV-related cirrhosis

Thrombocytopenia can be found in patients with liver cirrhosis related to hepatitis C virus. Both hypersplenism and increased platelet autoantibodies have been hypothesized as mechanisms responsible for thrombocytopenia. A 55-year-old man with hepatic cirrhosis secondary to hepatitis C and documented portal hypertension was admitted with hypersplenism, severe thrombocytopenia (900/μL) and gingival bleeding, which were refractory to corticosteroid therapy. Partial splenic embolization was performed radiologically by injection of polyvinyl alcohol particles. Splenic volume decreased 45% following the embolization. Over 10 days following the procedure, the platelet count increased progressively from 4,450 to 89,700/μL. Postembolization syndrome was the main side effect, but no life-threatening complications were detected. In conclusion, partial splenic embolization can be a safe and effective therapy for hypersplenism in cirrhosis.

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