IS INADEQUATE THROMBOPOIETIN PRODUCTION A MAJOR CAUSE OF THROMBOCYTOPENIA IN CIRRHOSIS OF THE LIVER

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.