nach oben

Digestive Diseases and Sciences

Erschienen in:

01.06.2007 | CASE REPORT

Liver Fibrosis Is Associated with Decreased Peripheral Platelet Count in Patients with Chronic Hepatitis B and C

verfasst von: Zeki Karasu, Fatih Tekin, Galip Ersoz, Fulya Gunsar, Yucel Batur, Tankut Ilter, Ulus S. Akarca

Erschienen in: Digestive Diseases and Sciences | Ausgabe 6/2007

Einloggen, um Zugang zu erhalten

Abstract

Thrombocytopenia is a common complication of chronic liver diseases, but its pathogenesis is not clear. Although generally attributed to hypersplenism, other factors should also be considered. We investigated the relationship between the peripheral platelet count and the degree of fibrosis in patients with chronic viral hepatitis. In an effort to avoid the effects of hypersplenism, we excluded patients with splenomegaly and/or bi- or pan-cytopenia. Seven hundred eighty-four patients (265 chronic viral hepatitis C and 519 chronic viral hepatitis B) were included in the study. Univariate analysis showed that the peripheral platelet count had a negative correlation with fibrosis score, necroinflammatory activity, and age in both groups. In multivariate analysis, the peripheral platelet count had a similar correlation with the fibrosis score and age, but not with necroinflammatory activity, in both groups. The peripheral platelet count decreased more significantly in females with chronic hepatitis C but not in the chronic hepatitis B group. In conclusion, a decrease in peripheral platelet count may be a sign of an increase in the degree of fibrosis during the course of chronic viral hepatitis B and C and factors other than hypersplenism may play a role in this decrease in the peripheral platelet count.

Morlock CG, Hall BE (1943) Association of cirrhosis, thrombocytopenia and hemorrhagic tendency. Arch Intern Med 72:69–77

Felix WR Jr, Myerson RM, Sigel B, Perrin EB, Jackson FC (1974) The effect of portacaval shunt on hypersplenism. Surg Gynecol Obstet 139:899–903PubMed

Soper NJ, Rikkers LF (1982) Effect of operations for variceal hemorrhage on hypersplenism. Am J Surg 144:70CrossRef

Morris PW, Patton TB, Balint JA, Hirschowitz BI (1962) Portal hypertension, congestive splenomegaly, and portacaval shunt. Gastroenterology 42:555–559

Mutchnick MG, Lerner E, Conn HO (1980) Effect of portacaval anastamosis on hypersplenism. Dig Dis Sci 25:929–938PubMedCrossRef

Hutson DG, Zeppa R, Levi JU, Schiff ER, Livingstone AS, Fink P (1977) The effect of the distal splenorenal shunt on hypersplenism. Ann Surg 185:605–612PubMedCrossRef

Frick V (1967) Thrombocytopenie und lebercirrhose. Scweiz Med Wochens 97:407–413

Fiore LD, Brophy MT, Deykin D (2003) Hemostasis. In: Zackim D, Boyer TD (eds) Hepatology: A textbook of liver disease. 4th edn. pp 562–563

Omata M (1998) Screening for hepatocellular carcinoma. In: Advances in therapeutic hepatology: A word view. Postgraduate course book. University of Chicago Press, Chicago, pp. 49–53

10.

Moschcowitz E (1948) The pathogenesis of splenomegaly in hypertension of the portal circulation: “congestive splenomegaly.” Medicine 27:187–221PubMed

11.

Landolfi R, Leone G, Fedeli G, Storti S, Laghi F, Bizzi B (1980) Platelet-associated IgG in acute and chronic hepatic diseases. Scand J Haematol 25:417–422PubMedCrossRef

12.

de Noronha R, Taylor BA, Wild G, Triger DR, Greaves M (1991) Interrelationships between platelet count, platelet IgG, serum IgG, immune-complexes and severity of liver disease. Clin Lab Haematol 13:127–135PubMedCrossRef

13.

Skootsky SA, Rosove MH, Langley MB (1986) Immune thrombocytopenia and response to splenectomy in chronic liver disease. Arch Intern Med 146:555–557PubMedCrossRef

14.

Paramo JA, Rocha E (1993) Hemostasis in advanced liver disease. Semin Thromb Hemost 19:184–190PubMedCrossRef

15.

Wehmeier A, Scharf RE, Schneider W (1990) Influence of splenectomy on platelet morphometry and function. Klin Wochenschr 68:847–852PubMedCrossRef

16.

Thomas HC, McSween RN, White RG (1973) Role of the liver in controlling the immunogenicity of commensal bacteria in the gut. Lancet 1:1288–1291PubMedCrossRef

17.

Triger DR, Wright R (1973) Hyperglobulinaemia in liver disease. Lancet 1:1494–1496PubMedCrossRef

18.

Kew MC (1996) Hepatitis B and C viruses and hepatocellular carcinoma. Clin Lab Med 16:395–406PubMed

19.

MacPherson AI, Innes J (1953) Peripheral blood picture after operation for portal hypertension. Lancet 1:1120–1123PubMedCrossRef

20.

Vang J, Simert G, Hansson JA, Thylen U, Bengmark TS (1977) Results of a modified distal spleno–renal shunt for portal hypertension. Ann Surg 185:224–228PubMedCrossRef

21.

Sullivan BH Jr, Tumen HJ (1961) The effect of portacaval shunt on thrombocytopenia associated with portal hypertension. Ann Intern Med 55:598–603PubMed

22.

Karasu Z, Gurakar A, Kerwin B, Hulagu S, Jazzar A, McFadden R, Nour B, Sebastian A, Cassidy F, Stokes K, Van Thiel DH, Wright H (2000) Effect of transjugular intrahepatic portosystemic shunt on thrombocytopenia associated with cirrhosis. Dig Dis Sci 45:1971–1976.

23.

Patton TB, Johnston CG, Lyons C, Jordan P Jr (1959) Lateral portacaval anastomosis for portal hypertension: long term results in 58 patients with intrahepatic portal bed block and 7 patients with extrahepatic portal bed block. Am J Gastroenterol 32:291–310PubMed

24.

Puttini M, Marni A, Montes F, Belli L (1979) Effect of portasystemic shunt on hypersplenism: Clinical study in 129 patients with cirrhosis. Am Surg 45:444–448PubMed

25.

Ferrara J, Ellison EC, Martin EW Jr, Cooperman M (1979) Correction of hypersplenism following distal splenorenal shunt. Surgery 86:570–573PubMed

26.

Malt RA (1976) Portasystemic venous shunts (part 1). N Engl J Med 295:24–29PubMedCrossRef

27.

Marni A, Trojsi C, Belli L (1981) Distal splenorenal shunt. Hemodynamic advantage over total shunt and influence on clinical status, hepatic function and hypersplenism. Am J Surg 142:372–376

28.

LaBerge JM, Ring EJ, Gordon RL, Lake JR, Doherty MM, Somberg KA, Roberts JP, Ascher NL (1993) Creation of transjugular intrahepatic portosystemic shunts with the wallstent endoprosthesis: results in 100 patients. Radiology 187:413–420PubMed

29.

Lawrence SP, Lezotte DC, Durham JD, Kumpe DA, Everson GT, Bilir BM (1995) Course of thrombocytopenia of chronic liver disease after transjugular intrahepatic portosystemic shunts (TIPS). A retrospective analysis. Dig Dis Sci 40:1575–1580CrossRef

30.

Alvarez OA, Lopera GA, Patel V, Encarnacion CE, Palmaz JC, Lee M (1996) Improvement of thrombocytopenia due to hypersplenism after transjugular intrahepatic portosystemic shunt placement in cirrhotic patients. Am J Gastroenterol 91:134–137PubMed

31.

Sungaran R, Markovic B, Chong BH (1997) Localization and regulation of thrombopoietin mRNA expression in human kidney, liver, bone marrow and spleen using in situ hybridization. Blood 89:101–107PubMed

32.

Martin TG 3rd, Somberg KA, Meng YG, Cohen RL, Heid CA, de Sauvage FJ, Shuman MA (1997) Thrombopoietin levels in patients with cirrhosis before and after orthotopic liver transplantation. Ann Intern Med 127:285–288PubMed

33.

Peck-Radosavljevic M, Zacherl J, Meng YG, Pidlich J, Lipinski E, Langle F, Steininger R, Muhlbacher F, Gangl A (1997) Is inadequate thrombopoietin production a major cause of thrombocytopenia in cirrhosis of the liver? J Hepatol 27:127–131PubMedCrossRef

34.

Ishikawa T, Ichida T, Matsuda Y, Sugitani S, Sugiyama M, Kato T, Miyazaki H, Asakura H (1998) Reduced expression of thrombopoietin is involved in thrombocytopenia in human and rat liver cirrhosis. J Gastroenterol Hepatol 13:907–913PubMed

35.

Stiegler G, Stohlawetz P, Peck-Radosavljevic M, Jilma B, Pidlich J, Wichlas M, Hocker P, Panzer S (1998) Direct evidence for an increase in thrombopoiesis after liver transplantation. Eur J Clin Invest 28:755–759PubMedCrossRef

36.

Yanaga K, Tzakis AG, Shimada M, Campbell WE, Marsh JW, Stieber AC, Makowka L, Todo S, Gordon RD, Iwatsuki S (1989) Reversal of hypersplenism following orthotopic liver transplantation. Ann Surg 210:180–183PubMedCrossRef

37.

Hutchison DE, Genton E, Porter KA, Daloze PM, Huguet C, Brettschneider L, Groth CG, Starzl TE (1968) Platelet changes following clinical and experimental hepatic homotransplantation. Arch Surg 97:27–33PubMed

38.

Rinkes IH, Van der Hoop AG, Hesselink EJ, Metselaar H, De Rave S, Zonderland HM, Schalm SW, Terpstra OT (1991) Does auxiliary heterotopic liver transplantation reverse hypersplenism and portal hypertension? Gastroenterology 100:1126–1128

39.

Ono E, Shiratori Y, Okudaira T, Imamura M, Teratani T, Kanai F, Kato N, Yoshida Y, Shiina S, Omata M (1999) Platelet count reflects stage of chronic hepatitis C. Hepatol Res 15:192–200CrossRef

40.

Matsumuro H, Moriyama M, Goto I, Tanaka N, Okubo H, Arakawa Y (2000) Natural course of progression of liver fibrosis in Japanese patients with chronic liver disease type C—a study of 527 patients at one establishment. J Viral Hepat 7:268–275CrossRef

41.

Okubo M, Shiota G, Kawasaki H (2000) Thrombopoietin levels in serum and liver tissue in patients with chronic viral hepatitis and hepatocellular carcinoma. Clin Sci (Lond) 99:207–214CrossRef

42.

Pohl A, Behling C, Oliver D, Kilani M, Monson P, Hassanein T (2001) Serum aminotransferase levels and platelet counts as predictors of degree of fibrosis in chronic hepatitis C virus infection. Am J Gastroenterol 96:3142–3146PubMedCrossRef

43.

Knodell RG, Ishak KG, Black WC, Chen TS, Craig R, Kaplowitz N, Kiernan TW, Wollman J (1981) Formulation and application of a numerical scoring system for assessing histological activity in asymptomatic chronic active hepatitis. Hepatology 1:431–435PubMedCrossRef

44.

Fusegawa H, Shiraishi K, Ogasawara F, Shimizu M, Haruki Y, Miyachi H, Matsuzaki S, Ando Y (2002) Platelet activation in patients with chronic hepatitis C. Tokai J Exp Clin Med 27:101–106PubMed

Titel: Liver Fibrosis Is Associated with Decreased Peripheral Platelet Count in Patients with Chronic Hepatitis B and C
verfasst von: Zeki Karasu
Fatih Tekin
Galip Ersoz
Fulya Gunsar
Yucel Batur
Tankut Ilter
Ulus S. Akarca
Publikationsdatum: 01.06.2007
Verlag: Kluwer Academic Publishers-Plenum Publishers
Erschienen in: Digestive Diseases and Sciences / Ausgabe 6/2007
Print ISSN: 0163-2116
Elektronische ISSN: 1573-2568
DOI: https://doi.org/10.1007/s10620-006-9144-y

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

25.04.2024 Allergien und Intoleranzreaktionen Nachrichten

Insektenstiche sind bei Erwachsenen die häufigsten Auslöser einer Anaphylaxie. Einen wirksamen Schutz vor schweren anaphylaktischen Reaktionen bietet die allergenspezifische Immuntherapie. Jedoch kommt sie noch viel zu selten zum Einsatz.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 6/2007

Dexamethasone Damages the Rat Stomach but Not Small Intestine During Inhibition of COX-1

Detection and Treatment of Early Flat and Depressed Colorectal Cancer Using High-Magnification Chromoscopic Colonoscopy: A Change in Paradigm for Western Endoscopists?

Metallothionein Expression in Helicobacter-Infected Pregnant Mice and Their Fetuses and Pups

Effect of Calcium Polycarbophil on Bowel Function After Restorative Proctocolectomy for Ulcerative Colitis: A Randomized Controlled Trial

One Week of Esomeprazole Triple Therapy vs. 1 Week of Omeprazole Triple Therapy Plus 3 Weeks of Omeprazole for Duodenal Ulcer Healding in Helicobacter pylori-Positive Patients