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2016 ; 8
(ä): 39-50
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The pathophysiology of thrombocytopenia in chronic liver disease
#MMPMID27186144
Mitchell O
; Feldman DM
; Diakow M
; Sigal SH
Hepat Med
2016[]; 8
(ä): 39-50
PMID27186144
show ga
Thrombocytopenia is the most common hematological abnormality encountered in
patients with chronic liver disease (CLD). In addition to being an indicator of
advanced disease and poor prognosis, it frequently prevents crucial
interventions. Historically, thrombocytopenia has been attributed to
hypersplenism, which is the increased pooling of platelets in a spleen enlarged
by congestive splenomegaly secondary to portal hypertension. Over the past
decade, however, there have been significant advances in the understanding of
thrombopoiesis, which, in turn, has led to an improved understanding of
thrombocytopenia in cirrhosis. Multiple factors contribute to the development of
thrombocytopenia and these can broadly be divided into those that cause decreased
production, splenic sequestration, and increased destruction. Depressed
thrombopoietin levels in CLD, together with direct bone marrow suppression,
result in a reduced rate of platelet production. Thrombopoietin regulates both
platelet production and maturation and is impaired in CLD. Bone marrow
suppression can be caused by viruses, alcohol, iron overload, and medications.
Splenic sequestration results from hypersplenism. The increased rate of platelet
destruction in cirrhosis also occurs through a number of pathways: increased
shear stress, increased fibrinolysis, bacterial translocation, and infection
result in an increased rate of platelet aggregation, while autoimmune disease and
raised titers of antiplatelet immunoglobulin result in the immunologic
destruction of platelets. An in-depth understanding of the complex
pathophysiology of the thrombocytopenia of CLD is crucial when considering
treatment strategies. This review outlines the recent advances in our
understanding of thrombocytopenia in cirrhosis and CLD.