{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T18:29:34Z","timestamp":1760898574955},"reference-count":27,"publisher":"SMW Supporting Association","issue":"0102","license":[{"start":{"date-parts":[[2012,1,1]],"date-time":"2012-01-01T00:00:00Z","timestamp":1325376000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Swiss Med Wkly"],"abstract":"<jats:p>PRINCIPLES:  Hypersplenism can be defined by thrombocytopenia and\/or neutropenia resulting  from blood cell sequestration in an enlarged spleen. In multimorbid patients the  differential diagnosis of cytopenia is challenging and currently there is no  established test for diagnosing hypersplenism.\n        METHODS:  The epinephrine stimulation test (EST) measures changes in platelets,  neutrophil counts and spleen size following a subcutaneous epinephrine  injection. We retrospectively analysed the results of EST in 228 patients.\n        RESULTS:  Increases in neutrophils and platelets after epinephrine injection were  significantly greater in patients with enlarged than in patients with normal  size spleens. Using cutoffs of low, intermediate and high confidence EST was  positive in 69.8% vs. 41.3% (low confidence), 49.6% vs. 17.4% (intermediate  confidence) and 38.8% vs. 10.9% (high confidence) in patients with enlarged vs.  normal size spleens. Changes in platelet and neutrophil counts correlated with  each other and with changes in spleen size, confirming cell release from the  spleen during EST. When stratified according to the underlying diagnosis,  patients with liver disease had the strongest response to EST, patients with  malignant haematological diseases the weakest. In addition the  response to EST was significantly related to changes in platelet and neutrophil  counts after splenectomy, confirming the validity of our test. No serious side  effects occurred during EST.\n        CONCLUSION:  When used in a large patient cohort, EST is a safe and simple diagnostic test. In  this exploratory study EST is of value in evaluating patients with cytopenia and  a positive EST argues strongly for hypersplenism. Future studies should  prospectively evaluate EST for the management of patients with splenomegaly.<\/jats:p>","DOI":"10.57187\/smw.2012.13324","type":"journal-article","created":{"date-parts":[[2022,12,21]],"date-time":"2022-12-21T22:38:17Z","timestamp":1671662297000},"page":"w13324","source":"Crossref","is-referenced-by-count":4,"title":["Diagnosis  of hypersplenism with the epinephrine stimulation test"],"prefix":"10.57187","volume":"143","author":[{"given":"B","family":"Misselwitz","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"EB","family":"Bachli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P","family":"Kaiser","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"JS","family":"Goede","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"36756","published-online":{"date-parts":[[2012,1,1]]},"reference":[{"key":"19572","doi-asserted-by":"crossref","unstructured":"Peck-Radosavljevic M. Hypersplenism. Eur J Gastroenterol Hepatol. 2001;13(4):317\u201323.","DOI":"10.1097\/00042737-200104000-00004"},{"key":"19573","doi-asserted-by":"crossref","unstructured":"Bowdler AJ. Splenomegaly and hypersplenism. Clin Haematol. 1983;12(2):467\u201388.","DOI":"10.1016\/S0308-2261(21)00396-9"},{"key":"19574","unstructured":"Greer JP, Foerster J, Rodgers GM, Paraskevas F, Glader B, Arber DA, et al. Winthrobe\u2019s Clinical Hematology, 12th edition. 2009."},{"key":"19575","doi-asserted-by":"crossref","unstructured":"Aster RH. Pooling of platelets in the spleen: role in the pathogenesis of \u201chypersplenic\u201d thrombocytopenia. J Clin Invest. 1966;45(5):645\u201357.","DOI":"10.1172\/JCI105380"},{"key":"19576","unstructured":"Martin DW, Woeber KA, Smith LH. Hypersplenism. Calif Med. 1973;118(1):24\u20139."},{"key":"19577","unstructured":"Brubaker LH, Johnson CA. Correlation of splenomegaly and abnormal neutrophil pooling (margination). J Lab Clin Med. 1978;92(4):508\u201315."},{"key":"19578","doi-asserted-by":"crossref","unstructured":"Bishop CR, Rothstein G, Ashenbrucker HE, Athens JW. Leukokinetic studies. XIV. Blood neutrophil kinetics in chronic, steady-state neutropenia. J Clin Invest. 1971;50(8):1678\u201389.","DOI":"10.1172\/JCI106657"},{"key":"19579","doi-asserted-by":"crossref","unstructured":"Schaffner A, Fehr J. Granulocyte demargination by epinephrine in evaluation of hypersplenic states. Scand J Haematol. 1981;27(4):225\u201330.","DOI":"10.1111\/j.1600-0609.1981.tb00477.x"},{"key":"19580","doi-asserted-by":"crossref","unstructured":"Fehr J, Grossmann HC. Disparity between circulating and marginated neutrophils: evidence from studies on the granulocyte alkaline phosphatase, a marker of cell maturity. Am J Hematol. 1979;7(4):369\u201379.","DOI":"10.1002\/ajh.2830070409"},{"key":"19581","doi-asserted-by":"crossref","unstructured":"Schaffner A, Augustiny N, Otto RC, Fehr J. The hypersplenic spleen. A contractile reservoir of granulocytes and platelets. Arch Intern Med. 1985;145(4):651\u20134.","DOI":"10.1001\/archinte.145.4.651"},{"key":"19582","unstructured":"Downey MT. Estimation of splenic weight from ultrasonographic measurements. Can Assoc Radiol J. 1992;43(4):273\u20137."},{"key":"19583","unstructured":"O\u2019Reilly RA. Splenomegaly in 2,505 patients at a large university medical center from 1913 to 1995. 1963 to 1995: 449 patients. West J Med. 1998;169(2):88\u201397."},{"key":"19584","doi-asserted-by":"crossref","unstructured":"Kraus MD. Splenic histology and histopathology: an update. Semin Diagn Pathol. 2003;20(2):84\u201393.","DOI":"10.1016\/S0740-2570(03)00024-8"},{"key":"19585","doi-asserted-by":"crossref","unstructured":"Gielchinsky Y, Elstein D, Hadas-Halpern I, Lahad A, Abrahamov A, Zimran A. Is there a correlation between degree of splenomegaly, symptoms and hypersplenism? A study of 218 patients with Gaucher disease. Br J Haematol. 1999;106(3):812\u2013.","DOI":"10.1046\/j.1365-2141.1999.01616.x"},{"key":"19586","doi-asserted-by":"crossref","unstructured":"Shi BM, Wang XY, Mu QL, Wu TH, Xu J. Value of portal hemodynamics and hypersplenism in cirrhosis staging. World J Gastroenterol. 2005;11(5):708\u201311.","DOI":"10.3748\/wjg.v11.i5.708"},{"key":"19587","doi-asserted-by":"crossref","unstructured":"Liangpunsakul S, Ulmer BJ, Chalasani N. Predictors and implications of severe hypersplenism in patients with cirrhosis. Am J Med Sci. 2003;326(3):111\u20136.","DOI":"10.1097\/00000441-200309000-00001"},{"key":"19588","doi-asserted-by":"crossref","unstructured":"Chikamori F, Nishida S, Selvaggi G, Tryphonopoulos P, Moon JI, Levi DM, et al. Effect of liver transplantation on spleen size, collateral veins, and platelet counts. World J Surg;34(2):320\u20136.","DOI":"10.1007\/s00268-009-0314-x"},{"key":"19589","doi-asserted-by":"crossref","unstructured":"Pursnani KG, Sillin LF, Kaplan DS. Effect of transjugular intrahepatic portosystemic shunt on secondary hypersplenism. Am J Surg. 1997;173(3):169\u201373.","DOI":"10.1016\/S0002-9610(97)00006-8"},{"key":"19590","unstructured":"Alvarez OA, Lopera GA, Patel V, Encarnacion CE, Palmaz JC, Lee M. Improvement of thrombocytopenia due to hypersplenism after transjugular intrahepatic portosystemic shunt placement in cirrhotic patients. Am J Gastroenterol. 1996;91(1):134\u20137."},{"key":"19591","doi-asserted-by":"crossref","unstructured":"Zhu K, Meng X, Li Z, Huang M, Guan S, Jiang Z, et al. Partial splenic embolization using polyvinyl alcohol particles for hypersplenism in cirrhosis: a prospective randomized study. Eur J Radiol. 2008;66(1):100\u20136.","DOI":"10.1016\/j.ejrad.2007.04.010"},{"key":"19592","doi-asserted-by":"crossref","unstructured":"Lee CM, Leung TK, Wang HJ, Lee WH, Shen LK, Liu JD, et al. Evaluation of the effect of partial splenic embolization on platelet values for liver cirrhosis patients with thrombocytopenia. World J Gastroenterol. 2007;13(4):619\u201322.","DOI":"10.3748\/wjg.v13.i4.619"},{"key":"19593","unstructured":"Wang HY, Shih SC, Lin SC, Chang WS, Wang TE, Lin FJ, et al. Partial splenic embolization: 12-month hematological effects and complications. Hepatogastroenterology. 2008;55(86-87):1838\u201342."},{"key":"19594","doi-asserted-by":"crossref","unstructured":"Hayashi H, Beppu T, Masuda T, Mizumoto T, Takahashi M, Ishiko T, et al. Predictive factors for platelet increase after partial splenic embolization in liver cirrhosis patients. J Gastroenterol Hepatol. 2007;22(10):1638\u201342.","DOI":"10.1111\/j.1440-1746.2007.05090.x"},{"key":"19595","doi-asserted-by":"crossref","unstructured":"Feng K, Ma K, Liu Q, Wu Q, Dong J, Bie P. Randomized clinical trial of splenic radiofrequency ablation versus splenectomy for severe hypersplenism. 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