Severe portal hypertension (varices, ascites, splenic vein thrombosis) OR Child-Pugh B/C...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-SMZL-ORGAN-DYSFUNCTION`
Type	Red flag
Status	reviewed 2026-04-25 \| pending_clinical_signoff
Diseases	`DIS-SPLENIC-MZL`
Sources	`SRC-ESMO-MZL-2024` `SRC-NCCN-BCELL-2025`

Red Flag Origin

Definition	Severe portal hypertension (varices, ascites, splenic vein thrombosis) OR Child-Pugh B/C in HCV-associated SMZL — splenectomy contraindicated; rituximab monotherapy preferred.
Clinical direction	de-escalate
Category	organ-dysfunction

Trigger Logic

{
  "any_of": [
    {
      "finding": "portal_hypertension_severe",
      "value": true
    },
    {
      "finding": "child_pugh_class",
      "value": "B"
    },
    {
      "finding": "child_pugh_class",
      "value": "C"
    }
  ],
  "type": "composite_clinical"
}

Notes

Splenectomy was historic SMZL standard; modern practice prefers rituximab esp. in cirrhosis where surgery risk is prohibitive. Decision drives Indication, not 1L Algorithm class.

Used By

Algorithms

ALGO-SMZL-2L - ALGO-SMZL-2L