title: Relation of serum levels of thrombopoietin to thrombocytopenia in extrahepatic portal vein obstruction versus cirrhotic children.
abstract: BACKGROUND
  In patients with portal hypertension, thrombocytopenia in cirrhotics and noncirrhotics is thought to be caused by sequestration and destruction of platelets within a large spleen, suppression of platelet production in the bone marrow, and decreased activity of the hematopoietic growth factor thrombopoietin (TPO).
  
  
  OBJECTIVE
  Determining the level of TPO in cirrhotic thrombocytopenic patients and correlate it to the degree of disease severity and platelet count.
  
  
  METHODS
  A cross-sectional study conducted on 62 children; 25 cases with cirrhosis, 20 patients with extrahepatic portal vein obstruction (EHPVO), and 17 healthy age-matched and sex-matched controls. The severity of liver cirrhosis was graded according to the Child-Pugh classification. TPO was measured using the quantitative human TPO by enzyme-linked immunosorbant assay.
  
  
  RESULTS
  Serum TPO levels were significantly lower in the cirrhotic group compared with both EHPVO patients and healthy controls (P=0.01 for each). Both of the Child-Pugh B and C cirrhotic cases had significantly lower TPO levels compared with Child A cases (P=0.003). We found a significant positive correlation between platelet count and serum TPO level (r=0.56, P=0.004) in the cirrhotic group but not in the EHPVO group (r=0.1, P>0.05).
  
  
  CONCLUSIONS
  TPO underproduction contributes to thrombocytopenia in children with cirrhosis; whereas in children with EHPVO, TPO production is unaffected and thrombocytopenia is secondary to hypersplenism. TPO receptor agonists may be useful to improve platelet counts in the former group.
authors.affiliation: Pediatrics Department, Cairo University, Cairo, Egypt.
authors.forename: Rokaya
authors.initials: R
authors.lastname: El-Sayed
authors.forename: Mona Abou
authors.initials: MA
authors.lastname: El-Ela
authors.forename: Mona S
authors.initials: MS
authors.lastname: El-Raziky
authors.forename: Heba
authors.initials: H
authors.lastname: Helmy
authors.forename: Amany Abd
authors.initials: AA
authors.lastname: El-Ghaffar
authors.forename: Hanaa
authors.initials: H
authors.lastname: El-Karaksy
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000097:blood* / Q000175:diagnosis; D007223:Infant; D008103:Liver Cirrhosis / Q000097:blood* / Q000175:diagnosis; D008297:Male; D010976:Platelet Count; D011169:Portal Vein / Q000473:pathology*; D012720:Severity of Illness Index; D013921:Thrombocytopenia / Q000097:blood* / Q000175:diagnosis; D013926:Thrombopoietin / Q000097:blood*
chemical_list: D013926:Thrombopoietin