title: Thrombocytopenia associated with chronic liver disease.
abstract: Thrombocytopenia (platelet count <150,000/microL) is a common complication in patients with chronic liver disease (CLD) that has been observed in up to 76% of patients. Moderate thrombocytopenia (platelet count, 50,000/microL-75,000/microL) occurs in approximately 13% of patients with cirrhosis. Multiple factors can contribute to the development of thrombocytopenia, including splenic platelet sequestration, bone marrow suppression by chronic hepatitis C infection, and antiviral treatment with interferon-based therapy. Reductions in the level or activity of the hematopoietic growth factor thrombopoietin (TPO) may also play a role. Thrombocytopenia can impact routine care of patients with CLD, potentially postponing or interfering with diagnostic and therapeutic procedures including liver biopsy, antiviral therapy, and medically indicated or elective surgery. Therapeutic options to safely and effectively raise platelet levels could have a significant effect on care of these patients. Several promising novel agents that stimulate TPO and increase platelet levels, such as the oral platelet growth factor eltrombopag, are currently in development for the prevention and/or treatment of thrombocytopenia. The ability to increase platelet levels could significantly reduce the need for platelet transfusions and facilitate the use of interferon-based antiviral therapy and other medically indicated treatments in patients with liver disease.
authors.affiliation: Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA. nafdhal@bidmc.harvard.edu
authors.forename: Nezam
authors.initials: N
authors.lastname: Afdhal
authors.forename: John
authors.initials: J
authors.lastname: McHutchison
authors.forename: Robert
authors.initials: R
authors.lastname: Brown
authors.forename: Ira
authors.initials: I
authors.lastname: Jacobson
authors.forename: Michael
authors.initials: M
authors.lastname: Manns
authors.forename: Fred
authors.initials: F
authors.lastname: Poordad
authors.forename: Babette
authors.initials: B
authors.lastname: Weksler
authors.forename: Rafael
authors.initials: R
authors.lastname: Esteban
mesh_terms: D001792:Blood Platelets / Q000473:pathology; D002908:Chronic Disease; D006801:Humans; D008107:Liver Diseases / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D013921:Thrombocytopenia / Q000209:etiology* / Q000503:physiopathology; D013926:Thrombopoietin / Q000502:physiology
chemical_list: D013926:Thrombopoietin