Hyposplenism in alcoholic cirrhosis, facts or artifacts? A comparative analysis with non-alcoholic cirrhosis and extrahepatic portal venous obstruction

Background and Aims: Hyposplenism has been described in patients with alcoholic cirrhosis (AC). However, no data are available regarding hyposplenism in patients with non-alcoholic cirrhosis (NAC) and other forms of portal hypertension such as extrahepatic portal venous obstruction (EHPVO). The aim is to study the splenic functions in patients with AC, NAC, and EHPVO. Methods: Splenic functions were assessed consecutively in 22 patients with AC, 21 with NAC, and 23 with EHPVO. The tests included pitted red blood cells (RBC; %) and Howell-jolly bodies in the peripheral smear. Pitted RBCs>2% with or without the presence of Howell-jolly bodies were taken as indicators of hyposplenism. The splenic function in each group was compared with age-matched controls. Results: Hyposplenism was found in 10 (45.45%) patients with AC, six (28.57%) with NAC and one (4.34%) with EHPVO. The mean pitted RBCs were significantly increased in patients with AC (mean 4.93+/-1.36% vs control 1.22+/-0.17%, P<0.05), but not so with NAC (2.01±0.69%) and EHPVO (mean 0.99±0.1% vs control 0.66±0.1%, P>0.05). Howell-jolly bodies were seen in only four patients. The mean pitted RBCs were significantly higher among patients who were actively consuming alcohol (9.14+/-3.35%) compared to those who abstained at least for more than 24 weeks (2.0+/-1.3%, P<0.05). Conclusion: Hyposplenism is more common in AC patients, particularly those who are actively consuming alcohol compared with those who abstain. Patients with NAC have a lower incidence of hyposplenism, while in EHPVO patients, it is uncommon. (C) 2001 Blackwell Science Asia Pty Ltd.