Chronic hepatitis C-associated thrombocytopenia: aetiology and management

Abstract

Thrombocytopenia is perhaps the most common haematological abnormality in patients with chronic hepatitis C virus (HCV) infection. In these patients, the presence of thrombocytopenia may be a limiting factor when considering antiviral therapy and may be associated with decreased sustained virological response rates. Thrombocytopenia may interfere with diagnostic procedures such as liver biopsy, because of risk of bleeding.Pathogenetic mechanisms include hypersplenism secondary to portal hypertension, bone marrow suppression resulting from either HCV itself or interferon treatment, and aberrations of the immune system resulting in the formation of anti-platelet antibodies and/or immunecomplexes that bind to platelets and facilitate their premature clearance. The ability to increase platelet levels could significantly reduce the need for platelet transfusions and facilitate the use of interferon-based antiviral therapy and other medically indicated treatments in patients with liver disease. Therapeutic options include pharmacological and non-pharmacological therapies. This review summarizes the available data on these therapeutic options. KEYWORDS: thrombocytopenia, hepatitis C virus (HCV), cytokines Definition and prevalenceThrombocytopenia has been defined as a platelet count <150,000 cells/µL. In a recent systematic review, the definitions of thrombocytopenia varied between studies and were based either on platelet counts, with threshold levels ranging between <100,000 cells/µL and <180,000 cells/µL or on criteria set in haematological guidelines. The prevalence of thrombocytopenia related to chronic liver disease has been reported as 15% to 70% in patients with advanced fibrosis and portal hypertension, depending on the stage of the disease and the platelet level used to define thrombocytopenia. In patients with chronic HCV infection, the prevalence of thrombocytopenia ranged from 0.16% to 45.4% and more than half of the studies reported a prevalence of 24% or more. 1 Aetiology of thrombocytopenia in patients with chronic HCVThe pathophysiology of thrombocytopenia in patients with HCV-related chronic liver disease is complex and involves the interaction of multiple factors. In general, these factors may be

Mean platelet volume and mean platelet volume/platelet count ratio as markers for hepatocellular carcinoma in patients with chronic hepatitis C virus related cirrhosis

“…Chronic hepatitis caused by hepatitis C virus (HCV) has been documented as a possible cause of thrombocytopenia, even in the absence of cirrhosis (Fouad, 2013;Osada et al, 2012). This was demonstrated in the present study as the mean platelet counts were significantly lower in patients with CHC than control subjects.…”

Danazol one Month Treatment of Thrombocytopenia in Chronic Hepatitis C

“…The exact mechanism of Danazol on autoimmune thrombocytopenia is still unknown, but the present results suggest that HCV associated thrombocytopenia has, at least in part, an autoimmune mechanism [2,3] Thrombopoetin mimics (Romiplostin, Eltrombopag) are TPO -Receptor agonists, which act through increase production of platelets [13]. The use of Eltrombopag in HCV patients with thrombocytopenia is cost-effective [14].…”

“…In the present study, Danazol 400 mg for one month was given on the basis of least effective and safe dose and also for a short time (one month) to minimize risk of severe or undesirable adverse effects and to facilitate any intervention diagnostic or therapeutic procedures by elevation of platelet levels over a short a short time. The ability to increase platelet levels could significantly reduce the need for platelet transfusions and facilitate the use of other medication indicated treatments in patients with liver disease [3].…”

“…Patients with HCV seem to develop lower platelet levels than patients with other causes of cirrhosis due to bone marrow suppression either by HCV directly, or immune-mediated platelet destruction involving anti-platelet antibodies and/or immune complex associated platelet clearance [2,3] and impaired thrombopoietin production or activity resulting from hepatocellular damage [4,5].…”

“…The ability to increase platelet counts could also significantly reduce the need for platelet transfusion [2,3].…”