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What causes chronic liver disease and enlarged spleen with low blood counts?

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Practicing since : 2004
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How to increase cell count to normal. Hb, TLC and Platlets. Bone Marrow is OK. Spleen size 135 mm, HCV interferron non responder. LFT, T3, T4,TSH and all others KFT, LIPID are Normal. Taking Insulin since 2011. Age 57 years, No Carcinoma of Liver. Taking following medicines 1. Ciplar LA 40 mg per day 2. Insulin Humalog 18 B, 12 L 10 D + 14 units basalong at D 3. General Tonics like Vitamin E, Folic Tablets of Amway. Selenium, Zinc and Calcium with Vit D3 Being supervised by world renowned hepatologist. Fibroscan/EUS in Oct.2013 : LSM = 9.1. KPA Liver IQR = 1.4 KPA Successful Rate SR = 100% Hb 10.7, TLC = 2200, PLT = 65000 AFP = 6.89 A+ Blood Group, CTP = 6, Spleen = 15.07 cm Portal Vein = 14.2 cm (No SOL in Triphasic contrast MRI of Liver) Height 163 CM, Weight = 66 to 70 Kg Leading Tension free retired life. FBS = 100 to 150 Sugar PP or Random = 200 to 250 even after Insulin PLUS Metformin 1000 mg SR and completely sugar less diet. No ascitic fluid. SOS using : Dloo - Pracetamol 650 mg very very rarely and no other pain killer. OrnOf or Orni Tablet in case of the stomach infections and that too very rarely. Welcome to ask any question as i can discuss anything related to my clinical condition.
Posted Thu, 13 Feb 2014 in Blood Disorders
Answered by Dr. Indranil Ghosh 8 hours later
Brief Answer: Probably due to hypersplenism Detailed Answer: Hi Thanks for your query. As you have chronic liver disease with spleen enlarged, with low blood counts but normal marrow, this is most likely due to hypersplenism. The spleen is trapping and destroying the blood cells. There is no specific treatment for this except removal of spleen. But that increases infection risk. As your counts are within acceptable limits, it is best to wait and watch for now. Hope I have answered your query. I will be available to answer further followup queries, if any.
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Follow-up: What causes chronic liver disease and enlarged spleen with low blood counts? 1 hour later
What about the Hepatitis C factor Genotype 1 when I did not respond to international therapy of Interferron and Ribavirin and that too under the top Hepatologist in India like the Directors of PGI, AIIMS, Medanta and Sir XXXXXXX XXXXXXX Hospitals. I am not satisfied with your answer. Had it been so then top hepatologists and hematologists should not have ignored this suggestion as provided by you. Can you document your answer in patients like me. In Nov 11 I developed the cellulitus of left thigh and leg and had to be transfused blood and platlets to save life.
Answered by Dr. Indranil Ghosh 15 minutes later
Brief Answer: Please refer below Detailed Answer: Thanks for followup. Therapy for HCV has its limitations. Even best regimens have upto 80% success rates. It is unfortunate that it failed in your case. Regarding hypersplenism and splenectomy (spleen removal) as its treatment, there is enough data in world literature to support it. I will quote a study from my XXXXXXX mater AIIMS, where they found very good results (link - WWW.WWWW.WW . But we should be sure that it is due to enlarged spleen and the counts are so low as to cause complications. This can only be done by the treating physician. there are some studies (like blood pool scan, which can give some idea about hypersplenism. Hope this helps. regards
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Follow-up: What causes chronic liver disease and enlarged spleen with low blood counts? 7 hours later
Dr.Gosh, thanks for your reply. But you have not informed me the follow up action. I am not doctor by profession but I have learnt a lot about me clinical conditions. I am regularly checking for : 1. CBC along with ESR 2. LFT 3. KFT 4. urine 5. BP and Sugar 6. Thyroid Profile 7. AFP 8. HB1Ac ( Fair upto 7) 9. HCV Viral Count Last 345000 IU 10.LFT ( SGOT and SGPT came down from 120, 120 level to Normal due to my will power, tension free life and no bad habit like alcohol, smoking. 11. Serum Ferritin is very Low - supplemented by Folic Acid 12. Vit D3 deficiency is there supplemented by weekly dozes of and on anong with Calcium. 13. Triphasic Liver MRI findings already narrated above. 14. Last year in 2011 and 2012 I maintained the HB level at 15 to 16 which has slipped down to 9 to 11 currently, cause of worry. 15. Sugar Levels remain high despite all efforts be endocrinologist but HB1AC is still not bad. 15. HCV was detected in 2008 with Virus Load 36,00,000 which is now around 3,60,000. 16 Of an on say once or twice a week I have to take Dytar 5 mg to keep a check on fluid in the stomach through my serum creatinine remains less than 0.5 and Kidneys and Heart are functioning very fine. NOW TELL ME FOLLOWUP ACTION: 1. Diet 2. Life Style 3. Medication Your advice will be considered complete after you advise me your course of action. Otherwise I am well aware of my clinical conditions. Regards XXXX
Answered by Dr. Indranil Ghosh 41 hours later
Brief Answer: My answers below.. Detailed Answer: Regarding the diet, to help prevent muscle and fat loss, you need to eat foods high in energy and protein but the sugar needs to be restricted. Best will be to consult a dietician and formulate a plan according to your body status to provide adequate calories, protein but controlling sugar. By reducing the amount of salt you eat you can limit the amount of fluid that stays in your body. Medicines which you are taking seem to be reasonable. No specific drug can enhance your blood counts at this time and hence I can't recommend anything on that lines. Regarding lifestyle, your body mass index looks fine, so no significant weight loss is needed. You can try to maintain weight at this level, exercise regularly, at least one hour thrice weekly. Followup by regular blood tests as you are doing. if counts fall further, a call has to be taken for splenectomy. Regards
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