Mechanism of thrombocytopenia in chronic hepatitis C as evaluated by the immature platelet fraction
ABSTRACT Thrombocytopenia occurs frequently in chronic hepatitis C. The mechanism of this association was investigated utilizing the immature platelet fraction (IPF%) as an index of platelet production together with assay of thrombopoietin (TPO).
In a cross-sectional study, 47 patients with chronic hepatitis C were studied, 29 with thrombocytopenia and 18 without thrombocytopenia (six patients in each group were on interferon therapy).
IPF% was elevated in the thrombocytopenic compared with the nonthrombocytopenic group (9.0 ± 4.8% vs. 4.7 ± 2.4%, P < 0.001), and an increase in IPF% was significantly associated with thrombocytopenia on multivariable analysis (P < 0.05). Splenomegaly was more common in thrombocytopenic than in nonthrombocytopenic subjects (66% vs. 6%, P < 0.001), and on multivariable analysis, splenomegaly was the factor associated with the highest relative risk of thrombocytopenia (RR = 1.9, P < 0.05). IPF% values were elevated in a similar proportion of thrombocytopenic patients with and without splenomegaly (58% and 60%, respectively). There was no difference in TPO levels between thrombocytopenic and nonthrombocytopenic patients, and TPO levels were not related to the risk of thrombocytopenia on multivariable analysis. Significantly more thrombocytopenic than nonthrombocytopenic subjects had abnormal liver function tests, cirrhosis, and portal hypertension, and a decrease in serum albumin was significantly associated with thrombocytopenia (P < 0.005) on multivariable analysis.
Factors associated with liver disease in general are associated with thrombocytopenia in chronic hepatitis C. Peripheral platelet destruction or sequestration is the major mechanism for thrombocytopenia, with hypersplenism being an important cause. Low TPO levels were not related to the occurrence of thrombocytopenia in this study.
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ABSTRACT: Reticulated platelets (RPs), immature platelets newly released from the bone marrow into the circulation, have a high content of ribonucleic acid and are larger and more active in thrombus formation. This review compiles articles that evaluated RP in order to establish their clinical significance. RPs increase when platelet production rises and decrease when production falls. As such, the measurement of circulating RPs allows the assessment of thrombocytopenia, i.e., bone marrow production or peripheral destruction. RPs are a promising laboratory tool for evaluation of idiopathic thrombocytopenia (differentiating hypoproduction from accelerated platelet destruction), chemotherapy and after stem cell transplantation (predicting platelet recovery) and thrombocytosis (estimating platelet turnover). Additional randomized and well controlled clinical studies are required to clearly establish the significance of circulating RPs in other clinical conditions. Copyright © 2014 Elsevier B.V. All rights reserved.Clinica Chimica Acta 01/2015; 439C:143-147. DOI:10.1016/j.cca.2014.10.024 · 2.76 Impact Factor
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ABSTRACT: There are many potential causes of thrombocytopenia in patients with chronic hepatitis C (CHC). We sought to determine the association between thrombopoietin (TPO) level, immature platelet fraction (IPF), immunoglobulin G (IgG) level, spleen size, and the platelet count in CHC. We studied a consecutive sample of patients enrolled in an observational study at a referral-based research center, excluding subjects based on eligibility criteria. TPO, glycocalicin, and von Willebrand Factor (vWF) levels were determined using stored sera. Hepatic fibrosis was assessed via transient elastography (TE) when available, and clinical laboratory values and radiologic data were obtained from the medical record. We performed analyses of the relationships between independent variables and the platelet count. On univariate analysis, the following variables were significantly associated with the platelet count: age, alanine aminotransferase (ALT), direct bilirubin, total bilirubin, IPF, international normalized ratio (INR), spleen size, vWF, glycocalicin, fibrosis stage on liver biopsy, and TE (P-values all <0.05). A multivariable model determined that imputed TE score, TPO, IPF, and spleen size were independently associated with the platelet count (P-values all<0.05). The platelet count in CHC is significantly associated with fibrosis, TPO level, IPF, and spleen size. Our findings challenge the proposed mechanism of decreased TPO levels or decreased bone marrow production of platelets as a cause of thrombocytopenia in CHC. Future studies focusing on the effects of fibrosis and splenomegaly on platelets may shed more light on the pathophysiology of thrombocytopenia in patients with CHC. Copyright © 2015 Elsevier Ltd. All rights reserved.Thrombosis Research 02/2015; 135(5). DOI:10.1016/j.thromres.2015.02.010 · 2.43 Impact Factor
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ABSTRACT: The aim of this study was to investigate the interrelation between splenic siderotic nodules, hypersplenism and liver function in patients with liver cirrhosis. The splenic enhanced susceptibility-weighted angiography (ESWAN) and conventional magnetic resonance images of 33 patients with liver cirrhosis were retrospectively studied and the ESWAN images were graded. The distribution and prevalence of the image grades for patients with and without hypersplenism were evaluated. In addition, the splenic volume and the distribution of Child-Pugh and albumin scores were compared between patients with and without siderotic nodules, and the correlation between splenic volume and the ESWAN image grades were evaluated in the patients with siderotic nodules. The ESWAN images revealed splenic siderotic nodules in 24 patients. The distribution and prevalence of the ESWAN image grades were demonstrated to be significantly different (P<0.001) between patients with and without hypersplenism. Furthermore, significant differences were observed between patients with and without siderotic nodules with regard to splenic volume and the distribution of Child-Pugh and serum albumin scores (P<0.001). No significant correlation was demonstrated between splenic volume and the ESWAN image grades (P>0.05). In conclusion, a higher prevalence of splenic siderotic nodules (72.7%) was observed using the ESWAN sequence, in comparison with results from previous studies, obtained using the T1-spoiled gradient echo sequence. The presence of splenic siderotic nodules was consistent with the occurrence of hypersplenism and was interrelated with reserved liver function.Experimental and therapeutic medicine 08/2013; 6(2):445-450. DOI:10.3892/etm.2013.1135 · 0.94 Impact Factor