Spleen

I have yet to start any treatment, as I've just recieved results from testing. My next appointment is 2+ weeks away. I was wondering if not having a Spleen affects treatment, and if so, how? Seem to me as though it would have some type of impact. VL 23+mil, GT 1a, Grade 2, Stage 2. Thanks, M

[James10500]

I don't have a spleen. When I had it removed I had a blood transfusion, this may be where I got Hep C or the other tray I had pre '92.  But to answer your question no problem.  My doc is Gregory Everson author of "Hep C a survivors guide" he talks in his book about how the spleen is affected when the liver can't do it's job.  So I asked him about it. He said not having one won't be an issue with tx or attaining SVR. Hey I figure it's one less organ to worry about.....lol

[James10500]

I don't have a spleen. When I had it removed I had a blood transfusion, this may be where I got Hep C or the other tray I had pre '92.  But to answer your question no problem.  My doc is Gregory Everson author of "Hep C a survivors guide" he talks in his book about how the spleen is affected when the liver can't do it's job.  So I asked him about it. He said not having one won't be an issue with tx or attaining SVR. Hey I figure it's one less organ to worry about.....lol

[mlkinmb]

James,
Sounds like we lost the spleen about the same time. I also had been given 8 units of blood which seems to be right at the time when new testing started. So I also think that that was the time when I became infected. I will have to try to check out the book, good to hear that it may not be an issue, this has been a major concern. Thanks! M

[Bill1954]

Those with cirrhosis often develop thrompocytopenia, or low platelets; the platelets become sequestered in the spleen. I’ve read that one option to increase platelets enough to allow HCV therapy for that group is splenectomy; so I’m guessing the lack of a spleen doesn’t preclude success with HCV therapy.

--Bill

[mlkinmb]

My last WBC was               15.0 (H) Ref. shows 4.0 > 10.5
            RDW                     15.6 (H)                 11.7 > 15.0
            Platelets                 567 (H)                 140 > 415
            Neutrophils               34 (L)                   40 > 74
            Lymphs                    51 (H)                  14 > 46
            Lymphs(absolute)     7.5 (H)                 0.4 > 4.5
            Monocytes(absolute) 1.8 (H)                 0.1 > 1.0
Still wondering about the HIGHS and how they factor in the total picture.
The Lymphs both bother me, as do the Monocytes, also the LOW Neutrophils.
I need to take notes for my next ID visit, lots of questions to ask!
Thanks, M

[Cory255]

I haven't seen No Spleen on any inadvisable lists of who shouldn't be treated.  This tells me it wouldn't necessarily be a contradiction to TX.  Someone with say, clinically decompensated cirrohis would likely not be a candidate for TX.

One common classification is a scale from 0-4 where stage 0 indicates no fibrosis.  Stage 1 indicates; enlargement of the portal areas by fibrosis which is considered a small amount of fibrosis.  With Stage 2; this indicates fibrosis extending out from the portal areas with rare bridges between the portal area.  Stage 2, is also considered a greater amount of fibrosis or scarring.  Stage 3 indicates; many bridges of fibrosis that link up portal and central areas of the liver; and stage 4 indicates cirrhosis.
Have you considered pursuing the IL28B test with GT1?  

[James10500]

Thanks for the confirmation.  I was worried my about my Doctor, not knowing what he was talking about.  Here's his bio, looks kind of questionable.

Dr. Gregory T. Everson is the Chief Scientific Officer of HepQuant, LLC. He received his MD degree from Cornell Medical College, New York, NY and is currently a Professor of Medicine and Director of Hepatology at the University of Colorado, Denver. Dr. Everson has published over 300 original papers, books, and book chapters in peer-reviewed journals that include Hepatology, Clinics in Liver Disease, Gastroenterology, Journal of Hepatology, New England Journal of Medicine, The American Journal of Gastroenterology, Alimentary Pharmacology and Therapeutics, and Expert Reviews in Gastroenterology and Hepatology.

In conjunction with Hedy Weinberg, he has co-authored 5 editions of the popular “self-help” book, Living with Hepatitis C: A Survivor’s Guide, for patients and families. He is a frequently invited speaker and has presented his work at clinical and scientific meetings nationally and internationally. He is a principal investigator for the HALT-C trial (Hepatitis C Antiviral Long-Term Treatment Against Cirrhosis) for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health (NIH), and numerous other clinical trials.

Dr. Everson is a member of the American Association for the Study of Liver Diseases (AASLD), the American Society of Transplantation, the International Liver Transplant Society, and the International Association for the Study of the Liver. He is a member of the Transplant Hepatology Committee of the American Board of Internal Medicine and Transplant Hepatology of the Accreditation Council for Graduate Medical Education.

[Cory255]

Very impressive credentials there from M.D. Gregory Everson.  I haven't read any of his books yet, looks well qualified to me.  
M.D. Mark Sulkowski's assessment is consistent with Gregory Everson's:  
The spleen is an important part of the immune system and is not a "vital" organ.  In particular, the spleen has a role in the humeral of antibody part of the immune system as opposed to the cellular side of things (this is a simplification). The immunity involved in HCV treatment is in large part cell based with T cells attacking infected liver cells rather than antibody based. Therefore, I do not think that the spleen or the lack thereof will affect his chances of responding to therapy. In my experience, I have not seen any difference.

http://www.hopkins-hivguide.org/q_a/clinician/miscellaneous_questions/therapy__no_spleen.html?contentInstanceId=387654&siteId=7151

It is very important that you take extra precautions against severe infection. You need to take a twice daily dose of antibiotics, normally penicillin V.
Have certain vaccinations – pneumovax, HIB - a special flu vaccine, meningococcal C vaccine plus an annual flu vaccine.  Persons without a spleen should be vaccinated against pneumococcus, a bacteria that causes pneumonia.
The immunisations must be renewed with a booster, usually every five years, to make sure you are still protected.  
Take a look at this link, it's a factsheet with extra precautions and vaccinations people without spleens should be aware of:

http://www.aftercure.org/factsheets/splenectomy.htm

[James10500]

Great info.  I have been without a spleen for many years and I definitely have to take the precautions you mention.  I am glad to see this, info.  Thanks.

[Cory255]

Glad to hear it.  Sounds like a good idea to discuss at next Hepa meeting for sure.  

[mlkinmb]

Lots of good info, Thanks. I am current with flu and pneumonia shots. Having pneumonia in Sept. of 09 is what started the ball rolling to find the HCV. At first it was thought possible cancer/leuk. and had seen cancer doc. I've heard it said about having having pneumonia shot yearly also, researching that. Thanks to all! M

[Cory255]

Ah, you already got those.  Good thing your hcv didn't remain a mystery, and they found it.