Review article: thrombocytopenia in chronic liver disease.
BACKGROUND
Thrombocytopenia is a common finding in advanced liver disease. It is predominantly a result of portal hypertension and platelet sequestration in the enlarged spleen, but other mechanisms may contribute. The liver is the site of thrombopoietin (TPO) synthesis, a hormone that leads to proliferation and differentiation of megakaryocytes and platelet formation. Reduced TPO production further reduces measurable serum platelet counts.


OBJECTIVE
This paper describes the scope of thrombocytopenia in chronic liver disease and assesses the clinical impact in this patient population.


METHODS
A medline review of the literature was performed pertaining to thrombocytopenia and advanced liver disease. This data is compiled into a review of the impact of low platelets in liver disease.


RESULTS
The incidence of thrombocytopenia, its impact on clinical decision making and the use of platelet transfusions are addressed. Emerging novel therapeutics for thrombocytopenia is also discussed.


CONCLUSIONS
Thrombocytopenia is a common and challenging clinical disorder in patients with chronic liver disease. New therapeutic options are needed to safely increase platelet counts prior to invasive medical procedures as well as to counteract therapies that further exacerbate low platelets, such as interferon. An ideal compound would be orally available and safe, with rapid onset of action.
Poordad
F
F
Cedars-Sinai Medical Center, Center for Liver Disease and Transplantation, Los Angeles, CA 90048, USA. fred.poordad@cshs.org
D001778:Blood Coagulation Disorders; D002908:Chronic Disease; D006801:Humans; D008107:Liver Diseases / Q000150:complications*; D010346:Patient Care Management / Q000191:economics*; D010976:Platelet Count; D017713:Platelet Transfusion; D013921:Thrombocytopenia / Q000209:etiology* / Q000628:therapy; D013926:Thrombopoietin / Q000378:metabolism
D013926:Thrombopoietin