Transjugular Liver Biopsy in Patients with Hematologic Malignancy and Severe Thrombocytopenia

Wallace, Michael J.; Narvios, Aida; Lichtiger, Benjamin; Ahrar, Kamran; Morello, Frank A.; Gupta, Sanjay; Madoff, David C.; Hicks, Marshall E.

doi:10.1097/01.rvi.0000058413.01661.b9

Cited by 45 publications

(28 citation statements)

References 15 publications

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“…One of the purposes of this study was to determine the safety of TJLB, and the safety assessment is based on the complication rate. The complication rates after TJLB have been reported to be 0‐8.1% 6–8, 11, 13, 14. The overall complication rate of TJLB in this study was 1.8% (2/111), and there was only 1 major complication: intraperitoneal hemorrhage.…”

Section: Discussionmentioning

confidence: 45%

Transjugular liver biopsy in patients with living donor liver transplantation: Comparison with percutaneous biopsy

Kim

Sung

et al. 2008

Liver Transpl

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Transjugular liver biopsy (TJLB) is an alternative method of pathological diagnosis in patients with an established contraindication to percutaneous biopsy. Between November 2005 and July 2007, 111 TJLBs were attempted in 67 patients and 95 percutaneous liver biopsies (PCLBs) were attempted in 51 patients with living donor liver transplantation suspected of having rejection. Indications of TJLB included classic contraindications to PCLB and a postoperative period of less than 30 days. TJLB was performed a mean of 111.1 Ϯ 292.6 days after transplantation (range: 6-2478 days, median: 35 days), and PCLB was performed a mean of 534.7 Ϯ 591.6 days after transplantation (range: 6-2555 days, median: 299 days). Technical success was 99.1% in TJLB and 100% in PCLB, and there was no significant difference between these 2 groups (P ϭ 0.354). A clinical suspicion of rejection was confirmed by histopathology in 38 (34.2%) of 111 TJLBs and 38 (40.0%) of 95 PCLBs. The overall complication rates related to the procedure were 1.8% (2/111) in TJLB and 5.3% (5/95) in PCLB. Although there was no significant difference in complication rates between TJLB and PCLB (P ϭ 0.172), the patients who underwent TJLB showed significantly higher incidence of ascites, coagulopathy, and thrombocytopenia, given its indication. TJLB seems to be a safe and effective procedure for pathological diagnosis of rejection in patients with living donor liver transplantation when there is a high risk of complication with PCLB. Liver Transpl 14: 971-979, 2008.

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Section: Discussionmentioning

confidence: 45%

Transjugular liver biopsy in patients with living donor liver transplantation: Comparison with percutaneous biopsy

Kim

Sung

et al. 2008

Liver Transpl

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“…Severe TCP, defined as platelet count less than 50 Â 10 9 /L occurs in only 1% of patients [57]. This threshold is often used as a cut-off when managing patients with cirrhosis, as a contraindication for elective invasive procedures for example liver biopsy, paracentesis, thoracentesis, because of an assumed increased risk of bleeding [58][59][60][61]. Often platelet transfusions are used prophylactically to cover similar procedures.…”

Section: Thrombocytopenia and Cirrhosismentioning

confidence: 99%

Patients with liver cirrhosis suffer from primary haemostatic defects? Fact or fiction?

Violi

Basili

Raparelli

et al. 2011

Journal of Hepatology

156

162

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Patients with cirrhosis can have abnormalities in laboratory tests reflecting changes in primary haemostasis, including bleeding time, platelet function tests, markers of platelet activation, and platelet count. Such changes have been considered particularly relevant in the bleeding complications that occur in cirrhosis. However, several studies have shown that routine diagnostic tests, such as platelet count, bleeding time, PFA-100, thromboelastography are not clinically useful to stratify bleeding risk in patients with cirrhosis. Moreover, treatments used to increase platelet count or to modulate platelet function could potentially do harm. Consequently the optimal management of bleeding complications is still a matter of discussion. Moreover, in the last two decades there has been an increased recognition that not only bleeding but also thrombosis complicates the clinical course of cirrhosis. Thus, we performed a literature search looking at publications studying both qualitative and quantitative aspects of platelet function to verify which primary haemostasis defects occur in cirrhosis. In addition, we evaluated the contribution of qualitative and quantitative aspects of platelet function to the clinical outcome in cirrhosis and their therapeutic management according to the data available in the literature. From the detailed analysis of the literature, it appears clear that primary haemostasis may not be defective in cirrhosis, and a low platelet count should not necessarily be considered as an automatic index of an increased risk of bleeding. Conversely, caution should be observed in patients with severe thrombocytopenia where its correction is advised if bleeding occurs and before invasive diagnostic and therapeutic procedures.

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“…Liver biopsy Percutaneous liver biopsy [33] Laparoscopic liver biopsy [34,35] Transjugular liver biopsy [36] 291 patients with mild hemostatic abnormalities Bleeding risk greatest in patients with malignancy 50 procedures in each of 2 studies 50 patients with severe thrombocytopenia Paracentesis/thoracentesis [37][38][39] 608 procedures in patients with mild to moderate thrombocytopenia [37]; 628 thrombocytopenic patients (513 with cirrhosis) [38]; 4729 patients with liver disease-related ascites [39] Low risk of bleeding complications if platelets >50,000/lL IFN-based HCV antiviral therapy IFN therapy causes reductions in platelet counts in chronic HCV patients with and without cirrhosis [26] Recommendations from AGA [5]: dose reduction of PEG-IFN-a2a for platelets 25,000-50,000/lL, discontinuation if <25,000/lL Dose reduction of PEG-IFN-a2b for platelets 680,000/lL, discontinuation if 650,000/lL…”

Section: Procedures Patient Population Studied Commentsmentioning

confidence: 99%

“…While liver biopsies in CLD patients are generally associated with a low (0.3%) risk of bleeding complications [32], the number of procedures postponed due to concern over such possible complications is unknown. Many physicians require platelet counts of P80,000/lL to safely perform a percutaneous liver biopsy, but the data on the safety of laparoscopic and transjugular liver biopsies suggests that few complications occur with a platelet count above 50,000/lL [33][34][35][36].…”

Section: Procedures In Patients With Thrombocytopeniamentioning

confidence: 99%

Thrombocytopenia associated with chronic liver disease

Afdhal

McHutchison

Brown

et al. 2008

Journal of Hepatology

490

454

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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.

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Transjugular Liver Biopsy in Patients with Hematologic Malignancy and Severe Thrombocytopenia

Cited by 45 publications

References 15 publications

Transjugular liver biopsy in patients with living donor liver transplantation: Comparison with percutaneous biopsy

Transjugular liver biopsy in patients with living donor liver transplantation: Comparison with percutaneous biopsy

Patients with liver cirrhosis suffer from primary haemostatic defects? Fact or fiction?

Thrombocytopenia associated with chronic liver disease

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