Thrombocytopenia in Cirrhosis: A Review of Pathophysiology and Management Options

Moore, Andrew

doi:10.1002/cld.860

Cited by 26 publications

(27 citation statements)

References 14 publications

(25 reference statements)

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“…19,29,30 It is reasonable to see this phenomenon because absolute platelet count is affected by TPO, spleen size, autoimmune status, megakaryocyte mass in bone marrow, and the aforementioned viral effect. 16,29 We also found that the TPO level (32-3944 pg/mL) in patients was more variable, compared to the normal population (81.3-237.7 or 19.25-377.75 pg/ml). 29,35 This suggests that the ability of our patients to produce or destroy TPO differed signi cantly.…”

Section: Discussionmentioning

confidence: 51%

Baseline Thrombopoietin Level is Associated with Platelet Count Improvement in Thrombocytopenic Chronic Hepatitis C Patients After Direct-Acting Antiviral Agent Therapy

Chen

Lee

et al. 2020

Preprint

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Background Thrombocytopenia can rapidly improve in chronic hepatitis C (CHC) patients receiving direct-acting antiviral agents (DAA). The role of baseline (BL) thrombopoietin (TPO) in this phenomenon is unclear. Methods From June 2016 to February 2019, a total of 104 CHC patients receiving DAA, with a sustained virologic response and BL thrombocytopenia, at Dalin Tzu Chi Hospital, were enrolled in this retrospective study. Significant platelet count improvement and platelet count improvement ratio were analyzed for correlation with BL TPO. Results This cohort included 40 men (38.5%). Seventy-two (69.2%) patients had advanced fibrosis. The platelet count [median (range)] increased from 110.5 (32–149) × 103/µL at BL to 116.5 (40–196) and 118.0 (35–275) × 103/µL at end of treatment (EOT) and 12 weeks after EOT (P12), respectively, (EOT vs. BL, P < 0.001; P12 vs. BL, P < 0.001).BL TPO was positively correlated with significant platelet count improvement (P < 0.001), platelet count improvement ratio at EOT (P = 0.004), and P12 (P < 0.001). The area under the receiver operating characteristic curve and optimal cutoffs (pg/ml) were 0.77 (95% confidence interval, 0.67–0.86) and 120, respectively, for significant platelet count improvement prediction. The sensitivity, specificity, and accuracy were 88.6%, 71.7%, and 78.8%, respectively. Conclusions BL TPO level might be a useful marker for predicting significant platelet count improvement in thrombocytopenic patients after successful DAA therapy.

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Section: Discussionmentioning

confidence: 51%

Baseline Thrombopoietin Level is Associated with Platelet Count Improvement in Thrombocytopenic Chronic Hepatitis C Patients After Direct-Acting Antiviral Agent Therapy

Chen

Lee

et al. 2020

Preprint

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“…This result was also corroborated by other studies [ 19 , 29 , 30 ]. It is reasonable to see this phenomenon because absolute platelet count is affected by TPO, spleen size, autoimmune status, megakaryocyte mass in bone marrow, and the aforementioned viral effect [ 16 , 29 ]. We also found that the TPO level (32–3944 pg/mL) in patients was more variable, compared to the normal population (81.3–237.7 or 19.25–377.75 pg/ml) [ 29 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, this improvement, within short-term follow-up, is less likely due to changes in the fibrosis stage [11]. It suggests that factors other than fibrosis may play important roles, such as hypersplenism, thrombopoietic cytokines, antiplatelet antibody, or direct effect from hepatitis C virus (HCV) via suppressing hematopoiesis [3,[12][13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Baseline thrombopoietin level is associated with platelet count improvement in thrombocytopenic chronic hepatitis C patients after successful direct-acting antiviral agent therapy

Chen

Lee

et al. 2021

BMC Gastroenterol

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Background Thrombocytopenia can rapidly improve in chronic hepatitis C (CHC) patients receiving direct-acting antiviral agents (DAA). The role of baseline (BL) thrombopoietin (TPO) in this phenomenon is unclear. Methods From June 2016 to February 2019, a total of 104 CHC patients receiving DAA, with a sustained virologic response and BL thrombocytopenia, at Dalin Tzu Chi Hospital, were enrolled in this retrospective study. Significant platelet count improvement and platelet count improvement ratio were analyzed for correlation with BL TPO. Results This cohort included 40 men (38.5%). Seventy-two (69.2%) patients had advanced fibrosis. The platelet count [median (range)] increased from 110.5 (32–149) × 103/µL at BL to 116.5 (40–196) and 118.0 (35–275) × 103/µL at end of treatment (EOT) and 12 weeks after EOT (P12), respectively, (EOT vs. BL, P < 0.001; P12 vs. BL, P < 0.001). BL TPO was positively correlated with significant platelet count improvement (P < 0.001), platelet count improvement ratio at EOT (P = 0.004), and P12 (P < 0.001). The area under the receiver operating characteristic curve and optimal cutoffs (pg/ml) were 0.77 (95% confidence interval, 0.67–0.86) and 120, respectively, for significant platelet count improvement prediction. The sensitivity, specificity, and accuracy were 88.6%, 71.7%, and 78.8%, respectively. Conclusions BL TPO level might be a useful marker for predicting significant platelet count improvement in thrombocytopenic patients after successful DAA therapy.

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“…Moore, et al found that thrombocytopenia is the most common hematological abnormalities and is often the first abnormality seen in patients with chronic liver disease. 10 Platelet production is largely associated with thrombopoietin which is predominantly synthesized in the liver in parenchymal and sinusoidal endothelial cells and in the kidneys and small amounts are also made in bone marrow stromal cells. 10 Thrombopoietin binds to the c-mpl receptor on megakaryocytes, to regulates the differentiation into platelets.…”

Section: Discussionmentioning

confidence: 99%

Hepatic cirrhosis causes pancytopenia: a case report

Dana¹,

Mediana²,

Murti³

et al. 2021

Int J Adv Med

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Hepatic cirrhosis is a slow process liver disease, persisting over a long period of time, resulting in a progressive destruction, and is the final common pathological pathway. We report a case of 60-year-old man with hepatic cirrhosis and pancytopenia. He came to emergency room with chronic fatigue, light headed, and abdominal pain. In laboratory examination, hemoglobin 6.0 g/dL, red blood cell counts 2.8×106/mm3, platelets 58.000×103/mm3, leukocytes 3.800×103/mm3, and reactive HbsAg. Abdominal ultrasound revealed small liver with irregular edges, ascitic fluid, and enlarged spleen. The patient was treated with furosemide, spironolactone, lactulose and propranolol. The liver, or the hepatocyte constitutes a significant storage site for iron, produce erythropoietin and thrombopoietin. Hypersplenism causes retention of a large number of leukocytes, erythrocytes, and platelets in the spleen, and the number of retained blood cells can be 5.5-20 times higher than the normal level, thus facilitating capture, phagocytosis or destruction of blood cells by phagocytes resulting in peripheral cytopenias. This case illustrated that hepatic cirrhosis can cause pancytopenia. Therefore, we must look for any cause of pancytopenia in a patient with chronic liver disease. Lack of thrombopoietin and erythropoietin production, lack of iron storage in damaged hepatocyte, also splenic sequestration were the reason of pancytopenia in hepatic cirrhosis. Bone marrow examination is one of modalities that can be use, and still being recommended examination.

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Thrombocytopenia in Cirrhosis: A Review of Pathophysiology and Management Options

Cited by 26 publications

References 14 publications

Baseline Thrombopoietin Level is Associated with Platelet Count Improvement in Thrombocytopenic Chronic Hepatitis C Patients After Direct-Acting Antiviral Agent Therapy

Baseline Thrombopoietin Level is Associated with Platelet Count Improvement in Thrombocytopenic Chronic Hepatitis C Patients After Direct-Acting Antiviral Agent Therapy

Baseline thrombopoietin level is associated with platelet count improvement in thrombocytopenic chronic hepatitis C patients after successful direct-acting antiviral agent therapy

Hepatic cirrhosis causes pancytopenia: a case report

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