Thrombocytopenia associated with chronic liver disease

Abstract

Thrombocytopenia (platelet count <150,000/microL) is a common complication in patients with chronic liver disease (CLD) that has been observed in up to 76% of patients. Moderate thrombocytopenia (platelet count, 50,000/microL-75,000/microL) occurs in approximately 13% of patients with cirrhosis. Multiple factors can contribute to the development of thrombocytopenia, including splenic platelet sequestration, bone marrow suppression by chronic hepatitis C infection, and antiviral treatment with interferon-based therapy. Reductions in the level or activity of the hematopoietic growth factor thrombopoietin (TPO) may also play a role. Thrombocytopenia can impact routine care of patients with CLD, potentially postponing or interfering with diagnostic and therapeutic procedures including liver biopsy, antiviral therapy, and medically indicated or elective surgery. Therapeutic options to safely and effectively raise platelet levels could have a significant effect on care of these patients. Several promising novel agents that stimulate TPO and increase platelet levels, such as the oral platelet growth factor eltrombopag, are currently in development for the prevention and/or treatment of thrombocytopenia. 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.

Hemostatic balance in patients with liver cirrhosis: Report of a consensus conference

“…Platelet transfusion is still employed to reach such thresholds [128,129], but this practice lacks evidence-based support. Rheological studies indicated that normal platelet flow was adversely affected whenever hematocrit levels dropped to <25%, supporting the claim that this level should be maintained in patients with cirrhosis who bleed [130]. One unit of platelet concentrate (300 ± 30 × 10 9 /L) for every 10 kg of body weight is usually administered, and platelet count needs to be checked after 1 h [130].…”

“…Rheological studies indicated that normal platelet flow was adversely affected whenever hematocrit levels dropped to <25%, supporting the claim that this level should be maintained in patients with cirrhosis who bleed [130]. One unit of platelet concentrate (300 ± 30 × 10 9 /L) for every 10 kg of body weight is usually administered, and platelet count needs to be checked after 1 h [130]. However, a correlation between improved platelet counts and enhanced hemostasis has never been shown [13].…”

Platelet Transfusion Improves Liver Function in Patients with Chronic Liver Disease and Cirrhosis

“…Liver cirrhosis is the end stage of CLD and a major life-threatening health problem worldwide. One of common complications in patients with CLD and cirrhosis is thrombocytopenia (Afdhal et al 2008). Thrombocytopenia occurs in up to 64% of cirrhotic patients (Bashour et al 2000).…”

King’s Score may be More Effective in the Determination of Severe Fibrosis in Chronic Hepatitis B Infections

“…There are multiple causes of thrombocytopenia in chronic liver disease. Splenic sequestration of platelets, suppression of their production in the bone marrow, or a decrease in the hematopoietic growth factor (thrombopoietin) activity can reduce the platelet count (13). In advanced liver disease, an increase in AST level is due to a decrease in the clearance or increase in the release of AST as a result of mitochondrial damage.…”