Liver Fibrosis Is Associated with Decreased Peripheral Platelet Count in Patients with Chronic Hepatitis B and C

Abstract

Thrombocytopenia is a common complication of chronic liver diseases, but its pathogenesis is not clear. Although generally attributed to hypersplenism, other factors should also be considered. We investigated the relationship between the peripheral platelet count and the degree of fibrosis in patients with chronic viral hepatitis. In an effort to avoid the effects of hypersplenism, we excluded patients with splenomegaly and/or bi- or pan-cytopenia. Seven hundred eighty-four patients (265 chronic viral hepatitis C and 519 chronic viral hepatitis B) were included in the study. Univariate analysis showed that the peripheral platelet count had a negative correlation with fibrosis score, necroinflammatory activity, and age in both groups. In multivariate analysis, the peripheral platelet count had a similar correlation with the fibrosis score and age, but not with necroinflammatory activity, in both groups. The peripheral platelet count decreased more significantly in females with chronic hepatitis C but not in the chronic hepatitis B group. In conclusion, a decrease in peripheral platelet count may be a sign of an increase in the degree of fibrosis during the course of chronic viral hepatitis B and C and factors other than hypersplenism may play a role in this decrease in the peripheral platelet count.

Chronic hepatitis C virus infection: Prevalence of extrahepatic manifestations and association with cryoglobulinemia in Bulgarian patients

“…This can be explained by the large number of patients with cirrhosis in the present study. Platelet sequestration and destruction in the spleen [82,83] , along with low thrombopoetin production [83,84] play an important role in the pathogenesis of thrombocytopenia. However, a direct viral infection of the megakariocytes [85] and autoimmune mechanisms [86,87] cannot be ruled out.…”

Thrombocytopenia is more severe in patients with advanced chronic hepatitis C than B with the same grade of liver stiffness and splenomegaly

“…Because cirrhotic liver with advanced tissue fibrogenesis gives rise to portal hypertension, inducing splenic enlargement and congestion [2][3][4][5], splenomegaly has been considered to cause thrombocytopenia by increased sequestration and enhanced destruction of platelets [6,7]. However, the exact pathogenesis of thrombocytopenia in CLD is not yet fully understood [8][9][10][11].…”

Evaluation of Platelet Indices of HBsAg Positive Patients

“…Trombositopeni akut ve kronik karaciğer hastalıklarının sık karşılaşılan bir komplikasyonudur (12) . Düşük trombosit sayısı, ilerlemiş karaciğer fibrozisinin iyi bilinen bir belirtecidir.…”

“…Karaciğerde trombositlerin birikiminin, trombositopeni ve karaciğer fibrozisini indükleyen Stellat hücre aktivasyonuna neden olabildiği düşünülmektedir (3) . Bir çalışmada periferal platelet sayısında azalmanın kronik hepatit B sırasında fibrozis derecesinde artışın işareti olabildiği öne sürülmüştür (12) . Sekiz yüz yetmiş sekiz HBsAg pozitif hastada yapılan başka bir çalışmada, HBV DNA yükünde artış ile PLT ve PCT değerlerinde azalma tespit edilmiştir (20) .…”