Thrombocytopenia is more severe in patients with advanced chronic hepatitis C than B with the same grade of liver stiffness and splenomegaly
- 186 Downloads
Background and aim
The mechanism responsible for thrombocytopenia in chronic liver diseases (CLD) is not yet fully understood. The prevalence of thrombocytopenia has been reported to be higher in patients with hepatitis C virus-related hepatocellular carcinoma (CLD-C) than in those with hepatitis B virus-related hepatocellular carcinoma (CDC-B). We have examined the potential difference in thrombocytopenia between patients with CLD-B and those with CLD-C in terms of liver fibrosis adjustment and splenomegaly.
The study cohort consisted of 102 patients with CLD-B and 143 patients with CLD-C were enrolled. Liver stiffness, which is reported to be well correlated with the degree of liver fibrosis, was measured by transient elastography.
The analysis of covariance with liver stiffness as a covariate revealed that the platelet count was lower in CLD-C patients than in CLD-B patients. Following stratification for liver stiffness, thrombocytopenia was found to be more severe in CLD-C patients than CLD-B patients with advanced liver stiffness, whereas the degree of splenomegaly was not significantly different. The plasma thrombopoietin level was not different between CLD-B and CLD-C patients with advanced liver stiffness, and the immature platelet number was lower in CLD-C patients despite thrombocytopenia being more severe in these patients.
CLD-C patients with advanced liver stiffness presented with more severe levels of thrombocytopenia than CLD-B patients even with the same grade of splenomegaly. Impaired platelet production rather than enhanced platelet destruction may underlie the mechanism responsible for thrombocytopenia in patients with CLD.
KeywordsLiver stiffness Splenomegaly Thrombocytopenia Thrombopoietin Transient elastography
Analysis of covariance
Chronic liver disease
Hepatitis B envelope antigen
Hepatitis B surface antigen
Hepatitis B virus
Hepatitis C virus
Immature platelet fraction
- 2.National Institutes of Health. NIH Consensus Development Conference Statement: Management of hepatitis C. Hepatology. 2002;36:S3–20.Google Scholar
- 26.Fraquelli M, Rigamonti C. Diagnosis of cirrhosis by transient elastography: what is hidden behind misleading results. Hepatology 2007;46:282 (author reply, p. 283).Google Scholar
- 29.Kurata Y, Hayashi S, Kiyoi T, Kosugi S, Kashiwagi H, Honda S, et al. Diagnostic value of tests for reticulated platelets, plasma glycocalicin, and thrombopoietin levels for discriminating between hyperdestructive and hypoplastic thrombocytopenia. Am J Clin Pathol. 2001;115:656–64.CrossRefPubMedGoogle Scholar
- 37.Koike Y, Miyazaki K, Higashihara M, Kimura E, Jona M, Uchihashi K, et al. Clinical significance of detection of immature platelets: comparison between percentage of reticulated platelets as detected by flow cytometry and immature platelet fraction as detected by automated measurement. Eur J Haematol. 2010;84:183–4.CrossRefPubMedGoogle Scholar