Coagulation profile and platelet count in pediatric patients with extrahepatic portal vein obstruction

The aim of the study was to study coagulation abnormalities and hematimetric indices in pediatric patients with extrahepatic portal vein obstruction (EHPVO).

This was a retrospective and longitudinal study, which included 93 patients diagnosed with EHPVO treated between January 1991 and December 2023 at a reference center for pediatric liver diseases. The research was carried out by collecting data from the medical records of these patients, who were divided into three groups: G1 (n=78; EHPVO without surgery), G2 (n=4; EHPVO with surgery without splenectomy), and G3 (n=11; EHPVO with splenectomy).

The mean age at admission was 5.48 years, with 64.5% male patients and an average follow-up time of 10.42 years. At admission, the prevalence of prolonged R (thromboplastin time Ratio) and INR (international normalized ratio) was 52.32% and 26.8%, respectively; anemia was observed in 67.7% of patients, and thrombocytopenia in 70.45%. In the comparison of each variable between admission and the last follow-up, it was observed that for R, INR, and platelets, there was no significant difference in group 1. However, there was a significant difference in group 3, with a reduction in R and INR at the last follow-up compared to admission, and a significant increase in platelets between admission and the last follow-up. Owing to the reduced sample size, the outcomes of group 2 were excluded from the between-group comparisons due to limitationsin statistical power.

The percentage of anemia, thrombocytopenia, and prolonged INR at admission was high. Splenectomy resulted in an increase in platelet count and a reduction in R and INR. Therefore, the alteration in INR and R at admission is likely not due to the consumption of coagulation factors in the cavernoma region, but rather, probably in the spleen.