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Abstract
Portal hypertension is an important complication of liver cirrhosis, oesophageal varices development represent one of the most serious sequale of portal hypertension which ranges between 60-80% of cirrhotic patients. Many studies recommended periodic endoscopic examination of cirrhotic patients searching for O.V Recent studies concentrate on non invasive parameters for predication of O.V. Most of these study found that platelet count. Splenic size or both are good pridectors O.V. So, this work evaluate platelet count/splenic size ratio as a non invasive pridector for O.V and linking this ratio with O.V grades. The present study was carried out in Tropical Medicine and Clinical Pathology Departments, Faculty of Medicine, Zagazig University Hospitals. This work was carried out on 52 patients who were divided into 3 groups: Group I: Included 22 patients with no previous history of hematemesis or melena. Group II: Included 15 patients presented with first attack of hematemesis and/or melena, due to variceal bleeding. Group III: Included 15 patients presented with recurrent attacks of hematemesis and/or melena, due to variceal bleeding. All patients were subjected to full history taking and clinical examination, urine analysis stool analysis, liver and kidney functions, complete blood cell count, coagulations profile and manual platelet count. Ultrasonographic examination for assessment of splenic size using measurement for line A and line B and upper GIT endoscopy for evaluation of O.V. On ultrasound examination splenic size was calculated for each patient was higher in patients with recurrent attack (group III). The in patients with first attack of bleeding (group II) and patients without history of bleeding (group I). Splenic size also showed significant positive correlation in relation to O.V grades. Platelet count was higher in patient with no history of haematemsis and melena (group I) than in patients with first attack (group II) and patients with multiple attacks of bleeding (group III). Platelet count was also lower in patients having advanced O.V (grade III & IV) than patients having no oesophageal varices or early variceal (grade I and II) i.e negative correlation. Platelet count/splenic size ratio was higher in patient without bleeding (group I) than patient with bleeding (group II & III). Also platelet count/splenic size ratio showed highly statistical significant difference and negative correlation in relation to O.V grades, where the ratio was higher in patient without O.V than patients with small O.V grade I, II and showed more decrease in patient with advanced O.V grade III and IV.