Background: Large-volume paracentesis is the preferred treatment for patients with severe and refractory ascites. Several complications were reported during therapeutical paracentesis. However, there are very few published studies on the change in blood cell count after paracentesis. This study aimed to evaluate any changes in blood cell counts after ascites fluid drainage. Methods: This study was conducted on patients with severe ascites and chronic liver disease who underwent large-volume paracentesis at Namazi Hospital, in Shiraz, Iran, between March 2021 and February 2022. A data gathering form containing the patient’s medical history, cause of cirrhosis, ascites fluid volume, as well as routine tests including primarily sodium, potassium, and basal creatinine, was filled out. Before and after the surgery, the total blood cell count was measured. Before the procedure, adjustment was made in the case of coagulopathy and albumin deficiency. The effect of factors such as the volume of drained fluid, splenomegaly, antibiotics, and steroid use was assessed on the changes in the number of blood cells. Using the JAMOVI 2.3.9 software, a paired t test and multiple regression were applied for statistical analysis (P<0.001). Results: The study included 37 patients. After the paracentesis procedure, the number of blood cells significantly decreased in all groups (P<0.001). The followings are the amounts of each type of blood cells before and after the procedure: Platelet=153837±91862 and 115648±69136, red blood cells=3.53±0.784 and 3.22±0.705, white blood cells=12.3±7.78 and 8.6±5.5. None of the study variables, including drained volume, splenomegaly, antibiotics, and steroid use, were significant predictors of the changes in the blood cell count after paracentesis (P>0.001). Conclusion: The findings of the present study showed that children with tense ascites who had large-volume paracentesis might experience a sharp drop in blood cell count after the procedure, which was a transient physiological condition. |
- Wong F. Management of Ascites. In: Rahimi RS, editor. The Critically Ill Cirrhotic Patient: Evaluation and Management. Cham: Springer International Publishing; 2020. p. 11-30. doi: 10.1007/978-3-030-24490-3_2.
- Pedersen JS, Bendtsen F, Moller S. Management of cirrhotic ascites. Ther Adv Chronic Dis. 2015;6:124-37. doi: 10.1177/2040622315580069. PubMed PMID: 25954497; PubMed Central PMCID: PMCPMC4416972.
- Biggins SW, Angeli P, Garcia-Tsao G, Gines P, Ling SC, Nadim MK, et al. Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021;74:1014-48. doi: 10.1002/hep.31884. PubMed PMID: 33942342.
- Sen Sarma M, Yachha SK, Bhatia V, Srivastava A, Poddar U. Safety, complications and outcome of large volume paracentesis with or without albumin therapy in children with severe ascites due to liver disease. J Hepatol. 2015;63:1126-32. doi: 10.1016/j.jhep.2015.06.019. PubMed PMID: 26134185.
- Lane ER, Hsu EK, Murray KF. Management of ascites in children. Expert Rev Gastroenterol Hepatol. 2015;9:1281-92. doi: 10.1586/17474124.2015.1083419. PubMed PMID: 26325252.
- Bes DF, Fernandez MC, Malla I, Repetto HA, Buamsch D, Lopez S, et al. Management of cirrhotic ascites in children. Review and recommendations. Part 1: Pathophysiology, diagnostic evaluation, hospitalization criteria, treatment, nutritional management. Arch Argent Pediatr. 2017;115:385-90. doi: 10.5546/aap.2017.eng.385. PubMed PMID: 28737869.
- Fukui H, Saito H, Ueno Y, Uto H, Obara K, Sakaida I, et al. Evidence-based clinical practice guidelines for liver cirrhosis 2015. J Gastroenterol. 2016;51:629-50. doi: 10.1007/s00535-016-1216-y. PubMed PMID: 27246107.
- Salerno F, Guevara M, Bernardi M, Moreau R, Wong F, Angeli P, et al. Refractory ascites: pathogenesis, definition and therapy of a severe complication in patients with cirrhosis. Liver Int. 2010;30:937-47. doi: 10.1111/j.1478-3231.2010.02272.x. PubMed PMID: 20492521.
- Katz MJ, Peters MN, Wysocki JD, Chakraborti C. Diagnosis and management of delayed hemoperitoneum following therapeutic paracentesis. Proc (Bayl Univ Med Cent). 2013;26:185-6. doi: 10.1080/08998280.2013.11928956. PubMed PMID: 23543985; PubMed Central PMCID: PMCPMC3603744.
- Shah N, Shah B, Patel R, Van der Veer L, Snyder R, Livert D. Early Paracentesis-Induced Thrombocytopenia (EPIT): A Retrospective Study With Novel Insights Regarding Splenic Hemodynamics: 915. Official journal of the American College of Gastroenterology, ACG. 2018;113:S511. doi: 10.14309/00000434-201810001-00915.
- Patel PA, Ernst FR, Gunnarsson CL. Evaluation of hospital complications and costs associated with using ultrasound guidance during abdominal paracentesis procedures. J Med Econ. 2012;15:1-7. doi: 10.3111/13696998.2011.628723. PubMed PMID: 22011070.
- Tischer S, Miller JT. Pharmacologic Strategies to Prevent Blood Loss and Transfusion in Orthotopic Liver Transplantation. Crit Care Nurs Q. 2016;39:267-80. doi: 10.1097/CNQ.0000000000000120. PubMed PMID: 27254642.
- Sharzehi K, Jain V, Naveed A, Schreibman I. Hemorrhagic complications of paracentesis: a systematic review of the literature. Gastroenterol Res Pract. 2014;2014:985141. doi: 10.1155/2014/985141. PubMed PMID: 25580114; PubMed Central PMCID: PMCPMC4280650.
- Mosquera-Klinger G, Mayo-Patiño M, Suárez Y. Paracentesis, Appropriate Technique and Clinical Application. Universitas Medica. 2018;59:53-60. doi: 10.11144/Javeriana.umed59-1.para.
- Zernikow B. Symptomerfassung und-therapie. Palliativversorgung von Kindern, Jugendlichen und jungen Erwachsenen. 2013:145-375. doi: 10.1007/978-3-642-29610-9_6.
- Kockerling D, Nathwani R, Forlano R, Manousou P, Mullish BH, Dhar A. Current and future pharmacological therapies for managing cirrhosis and its complications. World J Gastroenterol. 2019;25:888-908. doi: 10.3748/wjg.v25.i8.888. PubMed PMID: 30833797; PubMed Central PMCID: PMCPMC6397723.
- Uchida Y, Uemura H, Tsuji S, Yamada S, Kouyama JI, Naiki K, et al. Significance of furosemide in patients with cirrhosis treated with or without zinc acetate hydrate supplementation. Hepatol Res. 2022;52:449-61. doi: 10.1111/hepr.13751. PubMed PMID: 35113468.
- Anand L, Choudhury A, Bihari C, Sharma BC, Kumar M, Maiwall R, et al. Flare of Autoimmune Hepatitis Causing Acute on Chronic Liver Failure: Diagnosis and Response to Corticosteroid Therapy. Hepatology. 2019;70:587-96. doi: 10.1002/hep.30205. PubMed PMID: 30113706.
- Chapman J, Bansal P, Goyal A, Azevedo AM. Splenomegaly. 2017.
- Woodhouse CA, Patel VC, Singanayagam A, Shawcross DL. Review article: the gut microbiome as a therapeutic target in the pathogenesis and treatment of chronic liver disease. Aliment Pharmacol Ther. 2018;47:192-202. doi: 10.1111/apt.14397. PubMed PMID: 29083037.
- Leber B, Spindelboeck W, Stadlbauer V. Infectious complications of acute and chronic liver disease. Semin Respir Crit Care Med. 2012;33:80-95. doi: 10.1055/s-0032-1301737. PubMed PMID: 22447263.
- Alves de Mattos A. Current indications for the use of albumin in the treatment of cirrhosis. Ann Hepatol. 2011;10:S15-20. PubMed PMID: 21566250.
- Albert M. Ultrasound for Critical Care Procedures. Basic Transesophageal and Critical Care Ultrasound. 2017:321.
- Shriver A, Rudnick S, Intagliata N, Wang A, Caldwell SH, Northup P. A Randomized Controlled Trial of Procedural Techniques for Large Volume Paracentesis. Ann Hepatol. 2017;16:279-84. doi: 10.5604/16652681.1231587. PubMed PMID: 28233752.
- Bernardi M, Caraceni P, Navickis RJ, Wilkes MM. Albumin infusion in patients undergoing large-volume paracentesis: a meta-analysis of randomized trials. Hepatology. 2012;55:1172-81. doi: 10.1002/hep.24786. PubMed PMID: 22095893.
- Ebrahimi AP, Nasiri Toosi M, Davoudi S, Jafarian A, Ghanaati H. Inferior Epigastric Artery Pseudoaneurysm Following Paracentesis in a Liver Graft Recipient: A Case Report. Iran J Radiol. 2015;12:e15517. doi: 10.5812/iranjradiol.15517v2. PubMed PMID: 26557270; PubMed Central PMCID: PMCPMC4632133.
- Scarlatescu E, Marchenko SP, Tomescu DR. Cirrhotic Cardiomyopathy-A Veiled Threat. Cardiol Rev. 2022;30:80-9. doi: 10.1097/CRD.0000000000000377. PubMed PMID: 33229904.
- Correale M, Tarantino N, Petrucci R, Tricarico L, Laonigro I, Di Biase M, et al. Liver disease and heart failure: Back and forth. Eur J Intern Med. 2018;48:25-34. doi: 10.1016/j.ejim.2017.10.016. PubMed PMID: 29100896.
- Kim D, Kim JS, Lee JH, Lee SC, Seo JS, Doh HH, et al. Does the large amount of ascites lateralize the inferior epigastric artery in liver cirrhosis? Journal of The Korean Society of Emergency Medicine. 2019;30:166-75.
- Widjaja FF, Khairan P, Kamelia T, Hasan I. Colloids Versus Albumin in Large Volume Paracentesis to Prevent Circulatory Dysfunction: Evidence-based Case Report. Acta Med Indones. 2016;48:148-55. PubMed PMID: 27550886.
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