Autoimmune thrombocytopenia in response to splenectomy in cirrhotic patients with accompanying hepatitis C.
OBJECTIVE
To estimate the contribution of autoimmune thrombocytopenia to hepatitis C virus-related liver cirrhosis (type C cirrhosis), we evaluated the influence of splenectomy upon platelet-associated immunoglobulin G (PAIgG) levels and platelet numbers.


METHODS
PAIgG titers and immune markers were determined in 24 type C cirrhotic patients with an intact spleen, 17 type C cirrhotic patients submitted to splenectomy, and 21 non-C cirrhosis with an intact spleen.


RESULTS
Thrombocytopenia (PLT < 15 x 10(4)/microL) in type C cirrhosis was diagnosed in all patients with an intact spleen, 8 patients submitted to splenectomy, and in 19 non-C cirrhosis with intact spleen. Elevated titers of PAIgG at more than 25.0 ng/10(7) cells were detected in all cirrhotic patients except for one splenectomized patient. PAIgG titers (ng/10(7) cells) were significantly higher in the type C cirrhosis with an intact spleen (247.9+/-197.0) compared with the splenectomized patients (125.6+/-87.8) or non-C cirrhosis (152.4+/-127.4). PAIgG titers were negatively correlated with platelet counts in type C cirrhotic patients with an intact spleen. In comparison with the type C cirrhosis with an intact spleen, the splenectomized patients had a reduced CD4/CD8 ratio and serum neopterin levels. The spleen index (cm2) was negatively correlated with platelet counts in the non-C cirrhosis, but not in the type C cirrhosis.


CONCLUSIONS
Our data indicate that the autoimmune mechanism plays an important role in thrombocytosis complicated by HCV-positive cirrhosis. In addition, splenectomy may impair T cells function through, at least in part, a reduction of CD4/CD8 ratio, consequently suppressing PAIgG production.
Sekiguchi
Tetsuro
T
Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Japan.
Nagamine
Takeaki
T
Takagi
Hitoshi
H
Mori
Masatomo
M
D000368:Aged; D001792:Blood Platelets / Q000276:immunology; D016516:CD4-CD8 Ratio; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C / Q000097:blood / Q000150:complications* / Q000276:immunology; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D019798:Neopterin / Q000097:blood; D010976:Platelet Count; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000097:blood / Q000150:complications* / Q000276:immunology*; D012367:RNA, Viral / Q000032:analysis; D012189:Retrospective Studies; D013154:Spleen / Q000473:pathology; D013156:Splenectomy
D007074:Immunoglobulin G; D012367:RNA, Viral; D019798:Neopterin