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Review
. 2014 Mar 14;20(10):2595-605.
doi: 10.3748/wjg.v20.i10.2595.

Management of thrombocytopenia due to liver cirrhosis: a review

Hiromitsu Hayashi  1 , Toru Beppu  1 , Ken Shirabe  1 , Yoshihiko Maehara  1 , Hideo Baba  1
Affiliations
Review

Management of thrombocytopenia due to liver cirrhosis: a review

Hiromitsu Hayashi et al. World J Gastroenterol. .

Abstract

Thrombocytopenia is a common complication in liver disease and can adversely affect the treatment of liver cirrhosis, limiting the ability to administer therapy and delaying planned surgical/diagnostic procedures because of an increased risk of bleeding. Multiple factors, including splenic sequestration, reduced activity of the hematopoietic growth factor thrombopoietin, bone marrow suppression by chronic hepatitis C virus infection and anti-cancer agents, and antiviral treatment with interferon-based therapy, can contribute to the development of thrombocytopenia in cirrhotic patients. Of these factors, the major mechanisms for thrombocytopenia in liver cirrhosis are (1) platelet sequestration in the spleen; and (2) decreased production of thrombopoietin in the liver. Several treatment options, including platelet transfusion, interventional partial splenic embolization, and surgical splenectomy, are now available for severe thrombocytopenia in cirrhotic patients. Although thrombopoietin agonists and targeted agents are alternative tools for noninvasively treating thrombocytopenia due to liver cirrhosis, their ability to improve thrombocytopenia in cirrhotic patients is under investigation in clinical trials. In this review, we propose a treatment approach to thrombocytopenia according to our novel concept of splenic volume, and we describe the current management of thrombocytopenia due to liver cirrhosis.

Keywords: Liver cirrhosis; Partial splenic embolization; Splenectomy; Thrombocytopenia; Thrombopoietin.

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Figures

Figure 1
Figure 1
Approaches to treat thrombocytopenia due to liver cirrhosis according to splenic volume. Thrombocytopenia is defined as fewer than 100 × 109/L. CT: Computed tomography; PSE: Partial splenic embolization; L-splenectomy: Laparoscopic splenectomy; BM: Bone marrow; HCV: Hepatitis C virus; TPO: Thrombopoietin.
Figure 2
Figure 2
Portal vein thrombosis after splenectomy (arrow).
See this image and copyright information in PMC

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