Liver and Spleen Stiffness in Hematological Diseases

Liver and spleen stiffness measurements are accurate, user-friendly non-invasive tests for the management of patients with chronic liver diseases. More recently, liver and spleen stiffness measurements have been investigated also for patients with hematological disorders in order to assess their potential role as non-invasive markers of disease severity. The primary use in patients with hematological disorders is towards the evaluation of secondary hepatic involvement. In this perspective, the most consistent results have been obtained in patients with major or intermediate thalassemia, where fibrosis and hepatic siderosis affect morbidity and mortality of patients. As regards thalassemic patients, several studies have shown a significant relationship between liver stiffness and liver fibrosis. In this setting elastography has proved to be reliable tool for assessing liver fibrosis: therefore, it can replace liver biopsy for the purpose of fibrosis staging. Similar results, even if supported by a lower number of studies, have been reported also in patients affected by sickle cell disease. As to the relationship between liver stiffness and the degree of iron overload, the results obtained both in thalassemic patients and in patients with sickle cell disease are conflicting, and in this setting, the influence of iron overload on liver stiffness results has yet to be clarified.