ABCD: Arquivos Brasileiros de Cirurgia Digestiva (Dec 2010)
Correlação entre esplenomegalia e plaquetopenia na forma hepatoesplênica da esquistossomose mansônica Correlation between splenomegaly and thrombocytopenia in hepatosplenic schistosomiasis
Abstract
RACIONAL: Sabe-se que tanto a leucopenia quanto a plaquetopenia têm relação direta com a esplenomegalia, mas não existem estudos correlacionando de forma direta ou precisa o tamanho do baço com o número de plaquetas. Ainda há controvérsia se a plaquetopenia observada em pacientes com doenças hepáticas crônicas está mais relacionada à esplenomegalia ou à própria hipertensão portal. OBJETIVO: Correlacionar o nível sérico das plaquetas nos períodos pré e pós-operatório imediato com peso e volume do baço em pacientes portadores da forma hepatoesplênica da esquistossomose com indicação para tratamento cirúrgico da hipertensão portal. MÉTODO: Foram analisados os prontuários de pacientes portadores da forma hepatoesplênica da esquistossomose mansônica submetidos a tratamento cirúrgico da hipertensão portal. Foram incluídos portadores com a doença confirmada pelo diagnóstico anatomopatológico da biópsia hepática realizada no período intra-operatório. Foram excluídos todos os doentes que apresentavam antecedentes de etilismo crônico, hepatite viral, evidências clínico-laboratoriais de insuficiência hepática ou alterações histopatológicas compatíveis com cirrose hepática. Foram avaliados: o tamanho e volume do baço; o nível sérico de plaquetas; o número de plaquetas. RESULTADOS: Foram identificados 141 pacientes que preenchiam os critérios de inclusão do total de 160 prontuários analisados. A idade média foi de 39,03 ± 12,74 anos (15 a 74 anos), sendo 84 homens (59,5%) e 57 mulheres (40,5%). O peso médio do baço foi de 966,27 ± 464,61 g (120 a 2700 g). O volume elíptico médio foi de 966,68 ± 499,12 cm3 (236,13 a 2782,36 cm³. Houve correlação estatisticamente significativa entre o peso e o volume elíptico do baço (pBACKGROUND: It is known that both leukopenia and thrombocytopenia were significantly correlated with splenomegaly, but there is no studies correlating directly or precisely the size of the spleen with the number of platelets. It is controversial whether the thrombocytopenia observed in patients with chronic liver disease is more related to splenomegaly or portal hypertension itself. AIM: To correlate the serum level of platelets in pre and postoperative weight and volume of the spleen in patients with hepatosplenic schistosomiasis with indication for surgical treatment of portal hypertension. METHODS: The medical records of patients with hepatosplenic schistosomiasis mansoni who underwent surgical treatment of portal hypertension were revised. Were included patients with the disease confirmed by pathologic diagnosis of liver biopsy performed during surgery, and excluded all patients who had a history of chronic alcoholism, viral hepatitis, clinical and laboratory evidence of hepatic or histopathological changescompatible with liver cirrhosis. Evaluation of the size and volume of the spleen, the serum level of platelets, the platelet count was done. RESULTS: Were identified 141 patients who met the inclusion criteria of the 160 charts analyzed. The mean age was 39.03 ± 12.74 years (15 to 74 years) and 84 men (59.5%) and 57 women (40.5%). The average weight of the spleen was 966.27 ± 464.61 g (120-2700 g). The elliptical volume averaged 966.68 ± 499.12 cm³ (from 236.13 to 2782.36 cm³. There was a statistically significant correlation between weight and volume of elliptical spleen (p<0.0001). The average number of platelets in preoperative period was 76.84 ± 43.64 x10³/mm³ below normal values (150-400 x10³/mm³). There was a statistically significant correlation between the numbers and logarithmic value of platelets in both preoperative with weight (p<0.01) with the elliptical volume (p<0.05) spleen. The number of platelets in the immediate postoperative period was correlated inversely with the weight of the spleen removed (p=0.0297 ), the logarithm value of platelets is also correlated with weight. The model used did not predict the serum concentrations of platelets based on weight and spleen volume. CONCLUSION: The variations in serum levels of platelets in both pre and postoperative period in patients with hepatosplenic schistosomiasis were directly correlated to changes in weight and volume of the spleen. Splenomegaly was directly responsible for the variation in the number of platelets.
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