Blood chronic liver diseases

MTX is contraindicated in pregnant and nursing women, chronic liver disease, immunodeficiency, pleural or peritoneal effusions, leukopenia, thrombocytopenia, preexisting blood disorders, and creatinine clearance <40 mL/min. 

Anhaptoglobinemia or subnormal Hp values, often found in acute and chronic liver disease, and in mononucleosis, may also be caused by an increased consumption and not by decreased synthesis. In both disorders there exists a tendency for the development of splenomegaly, i.e., a tendency to retarded splenic blood flow with slightly shortened survival time of the red cells as a consequence. If we do not presume a half-life of Hp in normals below one day, the main part of the Hp catabolism must be secondary to Hb release. Hence, subnormal Hp values will probably appear in conditions with no clinically observable increased hemolysis or slightly decreased Hp synthesis. The latter may be a con-... 

Hepatitis B vaccine schedule consists of three injections given at time 0, 1 month after the first injection and a third injection given 6 months after the first injection. Patients at high risk are given a booster after 5 years to maintain the immunity profile. Patients receiving blood transfusions, haemophilia patients, patients with chronic liver disease, and haemodialysis patients are among the high-risk patients who should be vaccinated. 

Patients with psoriasis or RA who have any of the following alcoholism, alcoholic liver disease, or other chronic liver disease overt or laboratory evidence of immunodeficiency syndromes preexisting blood dyscrasias (eg, bone marrow hypoplasia, leukopenia, thrombocytopenia, significant anemia). 

Portal hypertension most commonly occurs as a consequence of chronic liver disease. Portal hypertension Is caused by Increased blood flow within the portal venous system and increased resistance to portal flow within the liver. Splanchnic blood flow is increased in patients with cirrhosis due to low arteriolar resistance that is mediated by increased circulating vasodilators and decreased vascular sensitivity to vasoconstrictors. Intrahepatic vascular resistance is increased in cirrhosis due to fixed fibrosis within the spaces of Disse and hepatic veins as well as reversible vasoconstriction of hepatic sinusoids and venules. Among the consequences of portal hypertension are ascites, hepatic encephalopathy, and the development of portosystemic collaterals—especially gastric or esophageal varices. Varices can rupture, leading to massive upper gastrointestinal bleeding. 

When patients suffer from chronic liver or kidney disease, the selection of the herbs and their dosages should be determined carefully to avoid placing an unnecessary workload on these weakened organs. At the same time, herbs that protect these organs and promote their function should also be included. For instance, acute or chronic liver diseases are mainly differentiated into a syndrome consisting of Spleen-Qi deficiency, damp-heat and heat-toxin accumulation, and herbs that treat this syndrome can be used. Chronic kidney diseases are mainly differentiated as Kidney-Yang and Spleen-Yang deficiency, dampness accumulation and heat-toxin in the blood. Herbs that treat this syndrome should be used in appropriate doses to help restore kidney function. 

Wilson s disease is a pathological accumulation of copper in tissue which is later released into the bloodstream, leading to anaemia, and final accumulation of copper in liver and brain. It is the result of a mutation in the Wilson s disease gene in chromosome 13 which ordinarily codes for a cation transporting ATPase so that copper can be incorporated into ceruloplasmin prior to excretion. Also known as ferroxi-dase, in acknowledgement of its primary function as an oxidoreductase responsible for electron transfer, this enzyme contains iron and, more importantly, six copper atoms. It accounts for the transport of 90% of copper in the plasma so any impairment in its production or efficacy has a major impact on copper homeostasis. The greatly reduced concentration of ceruloplasmin in the blood of Wilson s disease sufferers correlates with their inability to metabolize copper effectively. It leads to chronic liver disease, for which the only real cure is a liver transplant,... 

McLean A, du Souich P, Gibaldi M. Noninvasive kinetic approach to the estimation of total hepatic blood flow and shunting in chronic liver disease — a hypothesis. Clin Pharmacol Ther 1979 25 161-6. 

The occurrence of hepatic encephalopathy (HE) is only possible under the following conditions (1.) a serious (acute or chronic) liver disease, in which the detoxification function is significantly restricted, has to be present, and/or (2.) a functional or anatomic portosystemic collateral circulation must exist — this can be placed surgically or in the form of a TIPS (72, 90) -through which the nondetoxified portal blood bypasses the liver, so that toxic substances can reach the brain. 

Liver disease includes many diverse conditions. A distinction can be made between acute and chronic liver disease with respect to changes in clearance. Acute states do not generally seem to influence metabolic clearance of most drugs, but chronic states, such as cirrhosis, seem to decrease metabolic function to a greater degree. Also in cirrhosis, a portion of the blood flow... 

Kiyosawa K, Akahane Y, Nagata A, Koike Y, Furuta S. The significance of blood transfusion in non-A, non-B chronic liver disease in Japan. Vox Sang 1982 43(l) 45-52. 

A 39-year-old army officer had bouts of palpitation and dizziness. There were no risk factors for chronic liver disease apart from a family history of hemochromatosis. His cardiovascular and nervous systems were normal but there was 5 cm hepatomegaly. Percutaneous liver biopsy showed grade 4 siderosis in parenchymal and non-parenchymal liver cells and a mild inflammatory infiltrate with minimal portal fibrosis. He had 45 liters of blood venesected over the next 18 months and a repeat biopsy 3 years later showed a non-cirrhotic liver with no stainable iron. He developed a non-resectable primary hepatocellular clear cell carcinoma 17 years after the initial diagnosis. 

Anabolic steroids promote muscle development and, therefore, potentially enhance performance. Their use is forbidden or monitored closely in most countries. Sophisticated methodologies exist to detect these substances and their metabolites and to discriminate them from naturally occurring androgenic hormones in the blood and urine. Anabolic steroids may be employed as adjunctive therapy in horses with debilitating conditions or chronic liver disease, anemia and postsurgical... 

Wilson s disease An inherited condition in which copper fails to be excreted in the bile. Copper accumulates progressively in the liver, brain, kidney, and red blood cells. As the amount of copper accumulates, hemolytic anemia, chronic liver disease, and a neurological syndrome develop. 

Orito E, Mizokami M, Nalcano T, Wu R, Cao K, Ohba K, et al. GB virus C/hepatitis G virus infection among Japanese patients with chronic liver diseases and blood donors. Virus Res 1996 46 89-93. 

The brain pallidal Ti-weighed MRI signal hyperintensity was recorded in 10 women and 11 men (33-69 yrs) with chronic liver disease and the data were correlated with self-reported clinical neurological symptoms and blood serum Fe, Mn, bilirubin, alk. phosphatase and aspartate transaminase, erythrocyte Mn, and blood Hb and hematocrit levels. 

Social habits of patients have also been linked to erectile dysfunction. The vasoconstrictor effect of cigarette smoking may compromise blood flow to the corpora and decrease cavernosal filling. Excessive ethanol intake may lead to androgen deficiency, peripheral neuropathy, or chronic liver disease, all of which can contribute to erectile dysfunction. 

Methotrexate is now considered the DMARD of choice by many rheumatologists for treating rheumatoid arthritis. In psoriatic arthritis it not only treats the joint symptoms, but also improves the skin disease for most patients. Methotrexate is contraindicated in pregnant and nursing women. It is also contraindicated in patients with chronic liver disease, immunodeficiency, pleural or peritoneal effusions, leukopenia, thrombocytopenia, pre-existing blood disorders, and a creatinine clearance of less than 40 mL/min. 

---