Serum Thrombopoietin Levels and Its Relationship WithThrombocytopenia in Patients With Cirrhosis

Abstract

Background:Patients with cirrhosis usually have thrombocytopenia in discrete levels. The mechanism of thrombocytopenia is thought as splenic sequestration and destruction of platelets, impaired bone marrow generation and diminished hepatic thrombopoietin synthesis.Objectives:The aim of this study was to evaluate serum thrombopoietin levels and its relationship with thrombocytopenia at patients with cirrhosis.Patients and Methods:Ninety–two cirrhotic patients and 45 healthy controls without history or findings of pathologies that can effect thrombopoietin levels were enrolled by simple random sampling to patient and control groups of this case control study performed at Eskisehir-Turkey. Thrombopoietin was measured in serum samples with a solid phase enzyme-linked immune absorbent assay. Additionally, spleen size and volume index were determined.Results:Platelet counts were lower in patients with cirrhosis (97000 ± 8000/mm3) than in healthy subjects (240000 ± 51000/mm3, P < 0.001). Significant difference was determined for platelet counts among child A, B and C stages (Child A vs. Child B P < 0.05 Child A vs. Child C P < 0.001–Child B vs. Child C P < 0.05). Serum TPO concentration was higher (69 ± 12 pg/mL) in cirrhotic group than healthy controls (49 ± 9 pg/ml) (P < 0.05). No significant difference in TPO levels were found among the Child A, B and C stages (64 ± 11 pg/mL, 75 ± 13 pg/mL and 68 ± 10 pg/mL, respectively). Spleen size and SVI was significantly higher in the cirrhotic patients than healthy controls (148 ± 14 mm vs. 98 ± 11 mm, P < 0.001-9167 ± 287 cm2 vs. 4118 ± 123 cm2). Significant difference was determined for spleen size and spleen index among child A, B and C stages (Child A vs. Child B P < 0.05 Child A vs. Child C P < 0.001–Child B vs. Child C P < 0.05). TPO levels were significantly different between cirrhotic patients with platelet levels below 50.000/mm3 (n = 16, plt-count: 41000 ± 8300/mm3, TPO levels: 73 ± 7 pg/mL) and above 50.000/mm3 (n = 76, plt-count: 105000 ± 9500/mm3, TPO levels: 65 ± 10 pg/mL) (P < 0.01). In correlation analysis, there was a strong negative correlation between platelet count-spleen size (P < 0.001, r = -0.74) and platelet count–serum TPO levels (P < 0.001, r = -0.71).Conclusions:Our results suggest that liver cirrhosis does not cause impaired thrombopoietin production even in the late stage of disease. Thrombopoietin has no contribution for the occurrence of thrombocytopenia in cirrhosis; splenic sequestration seems to be the main factor.

Characteristics of Chronic Hepatitis B Virus Patients Related Liver Cirrhosis in a Tertiary Care Referral Hospital, Duhok, Iraqi Kurdistan

“…Our results showed that prothrombin time, and TSB were significantly higher among Child's B, whereas the value of the albumin was significantly lower. These findings were in agreement with other literatures [19]. Liver is the only organ for synthesis of albumin and thus liver cirrhosis impairs albumin synthesis.…”

Níveis Séricos De Trombopoetina: Um Alerta Para Alteração Renal Causada Por Hepatite C

“…Como mencionado previamente, níveis de trombopoetina e contagem de plaquetas são altamente correlacionados com dano da função hepática e severidade da fibrose hepática em pacientes infectados com VHC cronicamente 25 Por mais que níveis séricos baixos de TPO estejam associados com cirrose hepática, em alguns estudos foram encontrados níveis normais e até mesmo aumentados de TPO sérico em pacientes cirróticos 38 .…”

“…Concluíram, também, que infecção por HCV é altamente associada com trombocitopenia a qual está fortemente associada à dano hepatocelular e fibrose hepática. No entanto, trombocitopenia é uma anormalidade laboratorial que não pode ser considerada como um sintoma específico para diagnóstico 24 , mesmo sendo a anormalidade hematopoiética mais comum em pacientes com cirrose hepática crônica 38 .…”

Comparative efficacy and cost effectiveness of splenectomy and thrombopoietin prior to peginterferon and ribavirin therapy with compensatory cirrhosis associated with hepatitis C and thrombocytopenia

“…Patients with cirrhosis usually exhibit thrombocytopenia in discrete levels. The mechanism of thrombocytopenia is hypothesized to involve the splenic sequestration and destruction of platelets, impaired bone marrow generation and diminished hepatic thrombopoietin synthesis (23).…”