Type C chronic hepatitis associated with thrombocytopenia in two patients

Abstract

Portal hypertension in the presence of chronic hepatitis is generally thought to develop during the progression of the chronic hepatitis to cirrhosis. Before the establishment of assays for diagnosing hepatitis C virus infection, such a case of portal hypertension without liver cirrhosis could be misdiagnosed as idiopathic portal hypertension. It had not fully determined whether portal hypertension might precede the onset of cirrhosis in type C chronic hepatitis. This report presents two cases of women with chronic hepatitis C who developed severe thrombocytopenia; each showed splenomegaly and hypersplenism due to portal hypertension. Angiographic study and histological analysis were conducted to determine the cause of the portal hypertension. Histological evaluation showed an intrahepatic presinusoidal block pattern and fibrotic changes in the periportal area, but no evidence of liver cirrhosis or of other incidental complications such as idiopathic portal hypertension. Both of these patients exhibited normal platelet counts after splenectomy. Thus, type C chronic hepatitis can lead to portal hypertension, as demonstrated in these two patients.

High prevalence of autoimmune phenomena in hepatitis C virus antibody positive patients with lymphoproliferative and connective tissue disorders

“…Also, the development of antiphospholipid Ab in haemophilic patients has been linked to HCV infection (Al-Saeed et al, 1994). Finally, HCV markers have been detected in several patients with lymphoproliferative (Gruber et al, 1993;Ferri et al, 1994;Pozzato et al, 1994;Mussini et al, 1995) and autoimmune disorders (Almazio et al, 1992;Cacoub et al, 1992;Haddad et al, 1992;Carson et al, 1993;Johnson et al, 1993;Mariette et al, 1993;Siegel et al, 1993;Tran et al, 1993;Ueno et al, 1994;Yabu et al, 1994;Marchesoni et al, 1995;Munke et al, 1995;Weidensaul et al, 1995). These findings, though frequently anecdotal, question the relationship between HCV infection and the immune system.…”

“…In this regard, HCV infection has been shown to be associated with lymphoproliferative disorders, especially non-Hodgkin lymphomas (Gruber et al, 1993;Ferri et al, 1994;Pozzato et al, 1994;Mussini et al, 1995) and several autoimmune disorders have been related to HCV. The bestdocumented example is essential mixed cryoglobulinaemia Ferri et al, 1991;Casato et al, 1991;Agnello et al, 1992;Cacoub et al, 1993Cacoub et al, , 1994Pakula et al, 1993;Abel et al, 1993), but a high prevalence of anti-HCV has also been found in a variety of systemic and organ-specific autoimmune diseases, including systemic lupus erythematosus (SLE; Marchesoni et al, 1995), Sjogren's syndrome (SS; Haddad et al, 1992;Almazio et al, 1992;Mariette et al, 1993), rheumatoid arthritis (RA; Siegel et al, 1993;Ueno et al, 1994), vasculitis (Cacoub et al, 1992;Carson et al, 1993;Weidensaul et al, 1995;Munke et al, 1995), thyroid diseases (Tran et al, 1993), membranoproliferative glomerulonephritis ( Johnson et al, 1993), haemolytic anaemia and autoimmune thrombocytopenia (Yabu et al, 1994). Also, immunological disturbances that develop in haemophiliacs treated with factor VIII infusions may well be attributed, in large part, to HCV infection (Al-Saeed et al, 1994).…”

Crosstalk between Platelets and the Immune System: Old Systems with New Discoveries

“…Mechanistically, HCV core protein 1 has been shown to induce the generation of antibodies that cross-react with GPIIIa-(49–66), leading to platelet destruction [159]. However, it has been reported that sequestration of platelets in the enlarged spleen (due to portal hypertension and decreased production of thrombopoietin) may also contribute to the pathogenesis of HCV-associated thrombocytopenia [160, 161]. …”

Pathobiology of Secondary Immune Thrombocytopenia

“…In some parts of the world, hepatitis C virus (HCV) infection has been detected in up to 30% of patients presenting with immune thrombocytopenia, even in the absence of overt hepatitis. [110][111][112] The diagnosis of immune thrombocytopenia is confounded in patients with advanced liver disease because of hypersplenism 113,114 and decreased production of TPO. [115][116][117][118][119] Antiplatelet antibodies are so common as to lack diagnostic utility.…”