M. Peckradosavljevic et al., IS INADEQUATE THROMBOPOIETIN PRODUCTION A MAJOR CAUSE OF THROMBOCYTOPENIA IN CIRRHOSIS OF THE LIVER, Journal of hepatology, 27(1), 1997, pp. 127-131
Background/Aims: Thrombocytopenia secondary to cirrhosis of the liver
and portal hypertension is a well-known complication of advanced stage
liver disease, but theories about the underlying pathogenetic mechani
sms, mostly centering on splenic sequestration and destruction of plat
elets, have failed to solve the problem so far, Methods: Peripheral pl
atelet count and thrombopoietin levels in human plasma mere measured i
n 28 patients with cirrhosis of the liver, Seven of those patients und
erwent orthotopic liver transplantation and five patients portal decom
pression by transjugular intrahepatic portosystemic shunt, Thrombopoie
tin plasma levels were followed for 14 days after the interventions. R
esults: No measurable thrombopoietin was detectable in the plasma of 2
8 thrombocytopenic patients with cirrhosis of the liver, in contrast t
o thrombocytopenic patients without liver disease, Seven of these pati
ents with cirrhosis underwent orthotopic liver transplantation, result
ing in a rise of thrombopoietin levels within 2 days after transplanta
tion. The rise in platelet number followed with a mean lag of 6 days,
and shortly thereafter, thrombopoietin levels returned to levels below
the limit of detection, Five patients with thrombocytopenia, who unde
rwent only decompression of portal hypertension, showed no rise in eit
her thrombopoietin levels or platelet count, Conclusions: Thrombocytop
enia associated with liver disease may at least in part be attributabl
e to inadequate thrombopoietin production in the failing liver.