Thrombocytopenia in end-stage renal disease and chronic viral hepatitis B or C

Orășan, Olga Hilda; Urian, Laura; Ciulei, George; Breaban, Iulia; Stefan, Andreea Maria; Secara, Sorina Cezara; Taut, Adela Sitar; Sarlea, Simina Tarmure; Negrean, Vasile; Sampelean, Dorel; Paţiu, Ioan Mihai; Orășan, Remus; Cozma, Angela

doi:10.22543/7674.52.p236243

Cited by 3 publications

(4 citation statements)

References 25 publications

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“…Viral hepatitis (B or C) is another factor associated with thrombocytopenia in ESRD patients undergoing hemodialysis [35][36] . However, in our study, every patient received only heparin as an anticoagulant regimen, and patients with viral hepatitis (B or C) were excluded.…”

Section: Discussionmentioning

confidence: 99%

“…Although heparin-induced thrombocytopenia has been claimed to be associated with hemodialysis, according to some studies, the decreased platelet count was similar to the alternative anticoagulant regimen 34 . Viral hepatitis (B or C) is another factor associated with thrombocytopenia in ESRD patients undergoing hemodialysis 35 - 36 . However, in our study, every patient received only heparin as an anticoagulant regimen, and patients with viral hepatitis (B or C) were excluded.…”

Section: Discussionmentioning

confidence: 99%

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The spleen size in patients undergoing hemodialysis

Araújo

Suassuna

2021

Braz. J. Nephrol.

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Introduction: Inflammation promotes the progression of chronic renal failure, and the start of dialysis worsens inflammation. The enlargement of the spleen is associated with inflammation, and patients on hemodialysis may show a large spleen. The aim of the present study was to compare the spleen size of patients undergoing hemodialysis versus controls to update this thread. Methods: Controls and patients were eligible to participate in the study provided they were negative for serological markers of hepatitis B and C viruses and HIV, if they had no lymphoproliferative disorder, and if they were at least 18 years of age. Age, sex, and the duration of dialysis were recorded. Laboratory variables (hemoglobin, hematological cell count, serum creatinine) and the underlying cause of end-stage renal disease were analyzed. The spleen sizes of the patients were divided into tertiles. Results: The 75 controls and 168 patients selected were sex-matched. The patients were older, had larger spleens and lower platelet counts than controls. The relationship between spleen size and age in the controls and patients was quite similar. The patients in the first tertile of spleen size compared with those in the third were older and had a higher platelet counts. The underlying disease and dialysis vintage had no effect on spleen size. Discussion: The patients had larger spleens and a greater range of spleen sizes than the controls. In patients, the association between larger and smaller spleen with lower and higher platelet counts, respectively, sparked the speculation of occurrence of hypersplenism and hyposplenism.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The spleen size in patients undergoing hemodialysis

Araújo

Suassuna

2021

Braz. J. Nephrol.

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“…Hyaluronic acid (HA) was demonstrated to be useful for the detection of liver fibrosis in CHC patients, especially in cases where liver biopsy is restricted (such as end-stage renal disease) (24,25). CHC patients who responded to treatment with daclatasvir and asunaprevir had a lower value of HA at SVR compared to the baseline values (123 ± 43 vs. 71 ± 14 ng/mL, p<0.01), while nonrespondents showed no significant difference before and after the treatment (145 ± 43 vs. 172 ± 46 ng/mL, p = 0.465) (26).…”

Section: Serum Markers Of Liver Fibrosismentioning

confidence: 99%

The evaluation of liver fibrosis regression in chronic hepatitis C patients after the treatment with direct-acting antiviral agents – A review of the literature

Orășan¹,

Ciulei²,

Coste³

et al. 2019

JMMS

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The second-generation of direct-acting antiviral agents are the current treatment for chronic viral hepatitis C infection. To evaluate the regression of liver fibrosis in patients receiving this therapy, liver biopsy remains the most accurate method, but the invasiveness of this procedure is its major drawback. Different non-invasive tests have been used to study changes in the stage of liver fibrosis in patients with chronic viral hepatitis treated with the second-generation of direct-acting antiviral agents: liver stiffness measurements (with transient elastography or acoustic radiation force impulse elastography) or different scores that use serum markers to calculate a fibrosis score. We prepared a literature review of the available data regarding the long-term evolution of liver fibrosis after the treatment with direct-acting antiviral agents for chronic viral hepatitis C. Keywords  chronic viral hepatitis C, direct-acting antiviral agents, liver fibrosis Highlights ✓ Transient elastography is the routine investigation for liver fibrosis monitoring in patients with chronic viral hepatitis C treated with direct acting antiviral agents. ✓ The APRI and FIB-4 scores registered the highest decrease between the baseline and the end of the treatment in patients with chronic viral hepatitis C treated with direct acting antiviral agents.

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“…In addition, nephrologists hesitate to indicate liver biopsy in patients with end-stage renal disease (ESRD) because of platelet dysfunctions and the significant risk of hemorrhage. The severity of fibrosis can be estimated using biochemical indices such as serum hyaluronic acid (9,10), the aspartate aminotransferase-to-platelet ratio index (APRI), the aspartate aminotransferase/ alanine aminotransferase (AST/ALT) ratio, the Fibrosis 4 (Fib-4) score, FibroTest (11,12), and the measurement of liver stiffness with transient elastography (FibroScan) (13,14). The novelty of this review consists of evidencing the main variations of each parameter used in calculating the FibroTest score in hemodialysis patients, and how these changes may influence the final score (stage of fibrosis).…”

Section: Introductionmentioning

confidence: 99%

The influence of hemodialysis on FibroTest parameters

Orășan

Breaban

Stefan

et al. 2019

Revista Romana De Medicina De Laborator

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Chronic hepatitis C viral infection is an important cause of morbidity and mortality in patients with end-stage renal disease treated with hemodialysis. Liver fibrosis represents a main determinant of liver disease prognosis and clinical management, and its assessment by liver biopsy can decide treatment allocation. Although liver biopsy is the gold standard for staging liver fibrosis, it is an invasive procedure associated with complications that are more prevalent in patients with end-stage renal disease. FibroTest represents a surrogate marker of fibrosis which evaluates the levels of apolipoprotein A1, total bilirubin, haptoglobin, gamma-glutamyltransferase and α2-macroglobulin, generating a score that indicates the level of fibrosis. Discrepancies were observed in clinical practice between FibroTest score and histopathological findings. The aim of this study was to evaluate how hemodialysis influences the level of each FibroTest parameter and the final score. The systematic literature review conducted by us suggests that hemodialysis induces a reduction in apolipoprotein A1, haptoglobin and bilirubin levels, with an increase in gamma-glutamyltransferase and alpha-2-macroglobulin levels. In conclusion, hemodialysis modifies the levels of FibroTest parameters, suggesting that it may also have an impact on the accuracy of liver fibrosis assessment in hemodialysis patients.

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Thrombocytopenia in end-stage renal disease and chronic viral hepatitis B or C

Cited by 3 publications

References 25 publications

The spleen size in patients undergoing hemodialysis

The spleen size in patients undergoing hemodialysis

The evaluation of liver fibrosis regression in chronic hepatitis C patients after the treatment with direct-acting antiviral agents – A review of the literature

The influence of hemodialysis on FibroTest parameters

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