title: Prevalence of cirrhosis in patients with thrombocytopenia who receive bone marrow biopsy.
abstract: OBJECTIVE
  Thrombocytopenia is a common finding in patients with cirrhosis and may lead to unnecessary referral for bone marrow (BM) biopsy. To date, the prevalence of cirrhosis in patients with thrombocytopenia who receive BM biopsy is largely unknown.
  
  
  METHODS
  Between fiscal years 2006-2010, 744 patients (≥18 years) who underwent BM biopsies for thrombocytopenia at our hospital were identified retrospectively. 541 patients were excluded who had hematologic malignancies and received chemotherapy. Remaining 203 patients with predominant isolated thrombocytopenia were included in the study.
  
  
  RESULTS
  Of 203 patients, 136 (67%) had a normal and 67 (33%) had an abnormal BM examination. Prevalence of cirrhosis in the study population was 35% (95% CI: 28.4-41.9). 51% patients with normal BM were found to have cirrhosis compared to 3% of patients with abnormal BM exam (P < 0.0001). Common causes of cirrhosis were nonalcoholic steatohepatitis (NASH) (47%), followed by alcohol and Hepatitis C virus infection. Idiopathic thrombocytopenia and myelodysplastic syndrome were most frequent causes of thrombocytopenia in patients without cirrhosis. Patients with NASH had higher body mass index (BMI) (33.4 vs. 25.8, P < 0.001) and lower MELD scores (11.1 vs. 16, P = 0.028) when compared to non-NASH patients with cirrhosis.
  
  
  CONCLUSIONS
  Approximately, one third (35%) of patients with cirrhosis induced thrombocytopenia may undergo unwarranted BM biopsies. Clinical diagnosis of cirrhosis is still a challenge for many physicians, particularly with underlying NASH. We propose cirrhosis to be the prime cause of isolated thrombocytopenia.
authors: Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco Fresno Medical Education Program, Fresno, California 93701, USA. msheikh@fresno.ucsf.edu
authors: Muhammad Y
authors: MY
authors: Sheikh
authors: Rahim
authors: R
authors: Raoufi
authors: Pradeep R
authors: PR
authors: Atla
authors: Muhammad
authors: M
authors: Riaz
authors: Chad
authors: C
authors: Oberer
authors: Michael J
authors: MJ
authors: Moffett
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001853:Bone Marrow / Q000473:pathology*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D015995:Prevalence; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors; D013921:Thrombocytopenia / Q000209:etiology* / Q000473:pathology*; D055815:Young Adult