Hypersplenism erodes the body’s resistance The spleen plays an important role in both immunity and blood filtration. As the largest immune organ in the body, the spleen accounts for 25% of the total lymphoid tissue in the body and contains a large number of lymphocytes and macrophages, which are the center of cellular and humoral immunity of the body and exert anti-tumor effects through various mechanisms. In addition, the spleen has the function of blood filtration. The splenic artery and the venous sinus are separated by a sieve containing various phagocytic cells. The splenic artery pours blood into the sieve and flows slowly between its fissures. Senescent blood cells are removed by phagocytes in the spleen stagnation and undergo blood cell metabolism. It can be said that the spleen is the purifier of blood. However, hypersplenism compromises the normal spleen function. Hypersplenism increases the destruction of red blood cells, white blood cells and platelets, causing anemia and decreased complete blood picture, and low immune function, leading to a decrease in the body’s resistance. More than 30% of cirrhotic patients have hypersplenism Cirrhosis is a common disease and one of the main causes of death in China, clinically characterized by impaired liver function and portal hypertension. Splenic vein blood accounts for 20% to 40% of portal blood flow. The increase in portal vein pressure leads to obstruction of blood return to the spleen, which results in spleen stasis enlargement and subsequently hypersplenism. Hypersplenism is characterized by enlargement of the spleen and a decrease in one or several blood cell components with a corresponding increase in bone marrow hematopoietic cells. After splenectomy, the blood picture is normal or near normal and the symptoms resolve. Effective treatment of hypersplenism is an important measure in the treatment of cirrhosis, which allows peripheral blood cells to be reduced and improved to varying degrees, thus ensuring that various treatments can be carried out in a timely and effective manner. More than 30% of patients with cirrhosis have hypersplenism. Hypersplenism is the most “injured” platelet. How is hypersplenism diagnosed? The diagnosis is made based on the patient’s history of chronic hepatitis leading to cirrhosis and excluding other diseases that may cause hypersplenism. The degree of hypersplenism can be further determined by blood tests, such as absolute values of white blood cells and platelets, and by ultrasound and abdominal CT to determine the size of the spleen. In hypersplenic patients, platelets ≤ 75,000 and white blood cells ≤ 3,500 in 1 ml of blood. Patients with hypersplenism have the greatest decrease in platelets. And the more hypersplenism, the more thrombocytopenia. This is followed by white blood cells and the least red blood cells. This is due to the different lifespan of various blood cells. Normal platelets survive for 9.5 days, while platelet survival is shortened by less than 6 days in patients with hypersplenism. Platelet reduction affects clotting and causes bleeding; white blood cell reduction affects immunity and predisposes to infection; and red blood cell reduction appears as anemia. Hypersplenism can be cured without cutting the spleen. In the past, hypersplenism was often treated by surgical splenectomy. However, patients with cirrhosis are often prone to aggressive infections and slow recovery after splenectomy due to their poor physical condition and poor liver synthesis, metabolism and detoxification, making them suffer from pain. Therefore, some patients do not choose resection surgery even though they know the dangers of hypersplenism. It can rise within 24 hours, platelets can rise in 2 to 3 days, and white blood cells and platelets gradually recover or approach the normal range in 10 to 14 days. The red blood cell response is the slowest, starting to rise about 1 week after surgery, and the magnitude is small, taking 3 to 6 months to rise to its peak. Moreover, after treatment by partial splenic embolization, due to the reduction of blood supply to the splenic artery, the blood returning to the portal vein via the splenic vein is also reduced, reducing portal hypertension, rebounding peripheral hemoglobin, relieving splenomegaly, treating gastrointestinal bleeding, improving liver function, and relieving ascites. The advantages of this method are that it is less invasive, can be operated under local anesthesia, does not require a cesarean section, is simple to care for, has a quick postoperative recovery, has few complications, and most importantly, ensures normal spleen function. Mr. Qi, like the one described earlier, was later treated with partial trans-splenial embolization and has now recovered and been discharged from the hospital. Indications PSE is indicated for all patients with indications for surgical splenectomy, including secondary hypersplenism and primary hypersplenism of various causes, various hematologic diseases with indications for splenectomy, lymphoma, myelofibrosis, splenic rupture and post-transplant immunosuppressive therapy. Currently, PSE is performed in China for the following diseases: cirrhotic hypersplenism, hepatocellular carcinoma combined with hypersplenism, hepatic venous obstruction syndrome, idiopathic portal hypertension, and thalassemia.