Reticuloendothelial phagocytic function in human liver disease and its relationship to haemolysis

Summary. This study was undertaken to examine the hypothesis that enhanced reticuloendothelial (RE) phagocytosis and splenic sequestration of red blood cells are important aetiological factors in the haemolysis accompanying liver disease. RE phagocytic capacity (REPC) was measured by the rate of plasma disappearance of radio‐iodinated microaggregated human serum albumin (I‐MAA) in 57 patients with acute or chronic liver disease, and its relationship to splenic size, RBC survival and splenic sequestration of RBC was analysed. In addition, RE perfusion was measured using a tracer dose of I‐MAA, and the RE phagocytic index (REPI), an index of the individual cellular RE activity, independent of perfusion, was calculated. An increased REPI was found in all forms of liver disease, largely independent of aetiology or severity. REPC was normal in most forms of cirrhosis but was decreased in patients with alcoholic cirrhosis, many of whom had diminished RE perfusion, associated with clinical or radiographic evidence of portal systemic shunting. This decreased REPC was due to decreased RE perfusion since a close correlation between REPC and RE perfusion was demonstrated. The relationship between spleen size and REPC in patients with cirrhosis depended on the aetiology of the disease, since in alcoholic cirrhosis splenomegaly was usually indicative of portal hypertension, whereas in patients with active chronic hepatitis splenomegaly was often an integral part of the disease. A shortened RBC survival was demonstrated in 24 of 30 patients studied, but the degree of haemolysis did not correlate with REPC, REPI or splenic size. Furthermore, splenic sequestration of RBC could be demonstrated in only two patients. It would appear that in hepatic cirrhosis, the RE system, whether its phagocytic capacity is increased or decreased, removes effete RBC presented to it, but is not primarily responsible for the mild haemolytic process. Copyrigh