HEPATIC CIRRHOSIS

ASSOCIATION OF PLATELET COUNT, SPLENOMEGALY AND ESOPHAGEAL VARICES IN PATIENTS

Abstract

Objective: To see the association of platelet count, splenomegaly and development of oesophageal varices. Study Design: Observational study. Duration of study: One year from January 2010 to December 2010. Setting: Gastroenterology Department, Medical Unit III, Nishtar Hospital Multan. Methodology: One hundred ten cirrhotic patients were included. The record of these patients was scrutinized and data collected was entered and analyzed through SPSS 11. The patients were divided into three groups according to platelet count. Group I with platelet count less than 50000/mm3, group II with platelet count of 50000 to 100000/mm3 and group III with platelet count of 100000 to 150000/mm3. Similarly patients were also divided into three groups according to splenic size. Group I with splenic size 11 – 13 cm, group II with splenic size 13–16 cm and group III splenic size more than 16 cm. In each group presence of esophageal varices along with grading was noted. Results: The age of the patients varied from 15 to 80 years and mean age was 48.55 ± 13.88 years. Sixty five (59.1 %) were male and 45 (40.9%) were female. The hemoglobin level of these patients varied from 6.0 to 14.3 gm/100 ml with mean level of 9.23 ± 2.11gm/100ml. The platelet count varied from 22000 to 385000/mm3. The splenic size varied from 9 to 18 cm with mean of 12.53 ± 2.14 cm. Esophageal varices were detected in 102 cases. Seventeen cases were of grade I varices, 25 cases were of grade II varices, 40 cases were in grade III varices and 4 cases were in grade IV varices. Maximum number of grade-III (22 patients) and grade IV (3patients) esophageal varices occurred in patients having platelet count less than 50000/mm3. As the splenic size increases the grade of esophageal varices also increases. Maximum number of esophageal varices occur in grade II (25) followed by grade-III (37) in patients with splenic size in the range of 13 to 16 cm. Conclusions: A low platelet count and large splenic size are good non-invasive predictors of esophageal varices. These parameters can also accurately assess the presence of large varices. So a patient of cirrhosis with low platelet count and large spleen has an increased diagnostic yield of esophageal varices on upper GI endoscopy.