Serum thrombopoietin levels in patients with chronic hepatitis and liver cirrhosis

OBJECTIVE: Thrombocytopenia is a common manifestation of cirrhosis. The aim of this study was to examine the relationship between serum thrombopoietin concentrations, circulating platelet levels, and the stage of hepatic fibr osis in patients with chronic viral hepatitis. METHODS: The study included 48 patients with chronic viral hepatitis (14 wi th stage 1 fibrosis; five with stage 2 fibrosis; three with stage 3 fibrosi s; 26 with cirrhosis) and 30 healthy volunteers. Serum thrombopoietin level s were measured using an enzyme-linked immunosorbent assay. Spleen size, pl atelet counts, and prothrombin time were measured, RESULTS: Thrombopoietin levels of patients with fibrosis stage 1 (2.50 +/- 1.60 fmol/ml) or stage 2 (1.89 +/- 0.65)were significantly higher than thos e in patients with cirrhosis (1.21 +/- 0.55) or healthy volunteers (1.26 +/ - 0.74). Mean platelet counts of patients with cirrhosis (8.0 +/- 4.6 x 10( 4)/mu l) were significantly lower than those with fibrosis stage 1 (18.6 +/ - 3.9) or stage 2 (16.0 +/- 5.8), or healthy volunteers (24.5 +/- 7.3). Pat ients with cirrhosis had larger spleens (30.9 +/- 18.4 cm(2)) than those wi th fibrosis stage 1 (18.2 +/- 6.4). Platelet counts showed a significant in verse relationship to spleen size (rho = -0.51, p < 0.0005) and a significa nt positive relationship with thrombopoietin levels (rho = 0.34, p < 0.02). Thrombopoietin levels were significantly correlated to prothrombin time (r ho = 0.45, p < 0.005). CONCLUSIONS: Serum thrombopoietin levels are elevated in patients with an e arly stage of chronic viral hepatitis. As the disease progresses from mild fibrosis to cirrhosis, decreased production of thrombopoietin may contribut e to the Further development of thrombocytopenia in cirrhosis. (Am J Gastro enterol 1999;94:1918-1922. (C) 1999 by Am. Coll. of Gastroenterology).