Hepatic fibrosis plays a central role in the pathogenesis of thrombocytopenia in patients with chronic viral hepatitis

The pathogenesis of thrombocytopenia in chronic hepatitis is not well known . This study evaluated the relationship between liver injury, serum thrombo poietin. splenomegaly and thrombocytopenia in chronic viral hepatitis. Two hundred and nine patients were enrolled, 85 with splenomegaly and 124 witho ut. Thrombocytopenia was present in 71% and 23% of patients with or without splenomegaly respectively. In subjects with low platelet count, those with splenomegaly showed significantly lower platelet numbers than those withou t splenomegaly. The spleen size correlated with portal hypertension. An inv erse correlation between spleen size and platelet count was observed (r = - 0.54: P < 0.0001), In patients without splenomegaly, thrombocytopenia was a ssociated with the grade of fibrosis; platelet counts were the highest in p atients with fibrosis 0-2, lower in those with grade 3 (P < 0.008) and lowe st in those with grade 4 (P < 0.05). These findings were independent of dem ographic and biochemical characteristics, hepatic necroinflammatory activit y, portal hypertension and splenomegaly. Patients with normal platelet coun ts showed higher thrombopoietin levels than those with low platelet counts (P < 0.0001), An inverse correlation between thrombopoietin levels and fibr osis grade was observed (r = - 0.50; P < 0.0001), Median thrombopoietin lev els were 58 and 27 pg/ml for fibrosis grade 0-1 and grade 4 respectively (P < 0.001). These data indicate that advanced hepatic fibrosis, causing an a ltered production of thrombopoietin and portal hypertension. plays the cent ral role in the pathogenesis of thrombocytopenia in chronic viral hepatitis .